Provider Demographics
NPI:1881848950
Name:OWUSU, SONNIE K (NP)
Entity Type:Individual
Prefix:MS
First Name:SONNIE
Middle Name:K
Last Name:OWUSU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SONNIE
Other - Middle Name:C
Other - Last Name:KEKULAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:273 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1411
Mailing Address - Country:US
Mailing Address - Phone:718-629-3020
Mailing Address - Fax:
Practice Address - Street 1:5400 OLD COURT RD STE 300
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5100
Practice Address - Country:US
Practice Address - Phone:410-521-7337
Practice Address - Fax:410-521-7377
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221924363LP0200X
NYF381968363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics