Provider Demographics
NPI:1104125905
Name:BRACKETT, SONYA ANTOINETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:ANTOINETTE
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-0296
Mailing Address - Country:US
Mailing Address - Phone:716-562-7012
Mailing Address - Fax:716-562-7109
Practice Address - Street 1:6818 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9783
Practice Address - Country:US
Practice Address - Phone:716-562-7012
Practice Address - Fax:716-562-7109
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396993-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse