Provider Demographics
NPI:1245219369
Name:PERRY, SONDRA SUZETTE (PAC)
Entity type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:SUZETTE
Last Name:PERRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:SONDRA
Other - Middle Name:SUZETTE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1199 CHECKERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-9782
Mailing Address - Country:US
Mailing Address - Phone:570-295-9616
Mailing Address - Fax:
Practice Address - Street 1:1199 CHECKERBERRY LN
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-9782
Practice Address - Country:US
Practice Address - Phone:570-295-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002969L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34828Medicare UPIN