Provider Demographics
NPI:1255789699
Name:CARRAWAY, SONJA DENISE
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:DENISE
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-7017
Mailing Address - Country:US
Mailing Address - Phone:757-567-3292
Mailing Address - Fax:757-484-7074
Practice Address - Street 1:2900 ELM AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-7017
Practice Address - Country:US
Practice Address - Phone:757-567-3292
Practice Address - Fax:757-484-7074
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver