Provider Demographics
NPI:1457368169
Name:DEANTONIO, SONDRA (MD)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:DEANTONIO
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 1:663 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2013
Mailing Address - Country:US
Mailing Address - Phone:609-567-6042
Mailing Address - Fax:609-567-2722
Practice Address - Street 1:663 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2013
Practice Address - Country:US
Practice Address - Phone:609-567-6042
Practice Address - Fax:609-567-2722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA505922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8828601Medicaid
NJ047706Medicare ID - Type UnspecifiedMEDICARE INDV ID
NJ8828601Medicaid