Provider Demographics
NPI:1043282387
Name:BRAUDWAY, SONYA (OD)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:BRAUDWAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 AVE K SW
Mailing Address - Street 2:#200
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:863-297-5400
Mailing Address - Fax:863-293-9780
Practice Address - Street 1:250 AVENUE K SW
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3914
Practice Address - Country:US
Practice Address - Phone:863-297-5400
Practice Address - Fax:863-293-8230
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620484800Medicaid
U46162Medicare UPIN
FL20514Medicare PIN
FL620484800Medicaid