Provider Demographics
NPI:1740062116
Name:SMITH, SONYA YOLANDA
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:YOLANDA
Last Name:SMITH
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 1:2950 W CYPRESS CREEK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1796
Mailing Address - Country:US
Mailing Address - Phone:954-880-4070
Mailing Address - Fax:
Practice Address - Street 1:2950 W CYPRESS CREEK RD STE 306
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1796
Practice Address - Country:US
Practice Address - Phone:954-880-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist