Provider Demographics
NPI:1700106333
Name:CLEVELAND, SONYA NICOLE
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:NICOLE
Last Name:CLEVELAND
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 1:5490 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9523
Mailing Address - Country:US
Mailing Address - Phone:315-807-8571
Mailing Address - Fax:
Practice Address - Street 1:5490 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-9523
Practice Address - Country:US
Practice Address - Phone:315-807-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300252-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse