Provider Demographics
NPI:1881640464
Name:SONNI, RAJESWARI S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESWARI
Middle Name:S
Last Name:SONNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4322
Mailing Address - Country:US
Mailing Address - Phone:863-382-0566
Mailing Address - Fax:863-471-9340
Practice Address - Street 1:1354 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4322
Practice Address - Country:US
Practice Address - Phone:863-382-0566
Practice Address - Fax:863-471-9340
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28112OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL066920200Medicaid
FL28112OtherBLUE CROSS BLUE SHIELD OF FLORIDA