Provider Demographics
NPI:1447511266
Name:DEPASS-NEMBHARD, SONIA MARIE (MSC/ TSHH)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:MARIE
Last Name:DEPASS-NEMBHARD
Suffix:
Gender:F
Credentials:MSC/ TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MARLOWE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1127
Mailing Address - Country:US
Mailing Address - Phone:917-882-5337
Mailing Address - Fax:516-256-0404
Practice Address - Street 1:11 MARLOWE RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1127
Practice Address - Country:US
Practice Address - Phone:917-882-5337
Practice Address - Fax:516-256-0404
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY930328991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist