Provider Demographics
NPI:1063176121
Name:STARKS, SONJA L
Entity type:Individual
Prefix:MS
First Name:SONJA
Middle Name:L
Last Name:STARKS
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 1:1825 HOMEWOOD DR APT 517
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2571
Mailing Address - Country:US
Mailing Address - Phone:440-506-5723
Mailing Address - Fax:
Practice Address - Street 1:1825 HOMEWOOD DR APT 517
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2571
Practice Address - Country:US
Practice Address - Phone:440-506-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2023-08-16
Deactivation Date:2023-03-08
Deactivation Code:
Reactivation Date:2023-08-16
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant