Provider Demographics
NPI:1952422693
Name:SANON, SONY GARY (PA)
Entity Type:Individual
Prefix:
First Name:SONY
Middle Name:GARY
Last Name:SANON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:152 NE 167TH ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3400
Mailing Address - Country:US
Mailing Address - Phone:305-978-5069
Mailing Address - Fax:954-442-2545
Practice Address - Street 1:18802 SW 55 ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-6291
Practice Address - Country:US
Practice Address - Phone:305-978-5069
Practice Address - Fax:954-442-2545
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA003363363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical