Provider Demographics
NPI:1457074148
Name:SANON, WILLY (RT)
Entity Type:Individual
Prefix:
First Name:WILLY
Middle Name:
Last Name:SANON
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CORAL SPRINGS DR APT 108
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3855
Mailing Address - Country:US
Mailing Address - Phone:561-213-4964
Mailing Address - Fax:
Practice Address - Street 1:3200 CORAL SPRINGS DR APT 108
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3855
Practice Address - Country:US
Practice Address - Phone:561-213-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT11588227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered