Provider Demographics
NPI:1215640891
Name:JEEVANANDAM, SONYA FLORENCE
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:FLORENCE
Last Name:JEEVANANDAM
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 1:37 E ELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2181
Mailing Address - Country:US
Mailing Address - Phone:847-293-6625
Mailing Address - Fax:
Practice Address - Street 1:37 E ELLINGTON CT
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2181
Practice Address - Country:US
Practice Address - Phone:847-293-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily