Provider Demographics
NPI:1063994382
Name:DUSSEAULT, SONYA K (DO)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:K
Last Name:DUSSEAULT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SW 129TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1716
Mailing Address - Country:US
Mailing Address - Phone:954-430-9898
Mailing Address - Fax:954-430-9677
Practice Address - Street 1:1 SW 129TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1716
Practice Address - Country:US
Practice Address - Phone:954-430-9898
Practice Address - Fax:954-430-9677
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO6338207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program