Provider Demographics
NPI:1720963879
Name:MATHEW, SONIA
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MATHEW
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 1:290 W LAKE PARK RD APT 608
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3886
Mailing Address - Country:US
Mailing Address - Phone:682-718-2104
Mailing Address - Fax:
Practice Address - Street 1:290 W LAKE PARK RD APT 608
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3886
Practice Address - Country:US
Practice Address - Phone:682-718-2104
Practice Address - Fax:682-718-2104
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208574363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health