Provider Demographics
NPI:1821386053
Name:JEFFERIES, NGANDU SONIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NGANDU
Middle Name:SONIA
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5512
Mailing Address - Country:US
Mailing Address - Phone:607-953-4445
Mailing Address - Fax:
Practice Address - Street 1:1700 MONROE ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5512
Practice Address - Country:US
Practice Address - Phone:607-953-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0588011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry