Provider Demographics
NPI:1386837284
Name:MODY, SONYA M (MD)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:M
Last Name:MODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9836 W YEARLING RD # F-1300
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1376
Mailing Address - Country:US
Mailing Address - Phone:623-328-8664
Mailing Address - Fax:623-328-9432
Practice Address - Street 1:9836 W YEARLING RD # F-1300
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1376
Practice Address - Country:US
Practice Address - Phone:623-328-8664
Practice Address - Fax:623-328-9432
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0069055208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418055100Medicaid