Provider Demographics
NPI:1528162203
Name:LYNESS, SONDRA MARIE (PA)
Entity type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:MARIE
Last Name:LYNESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3600
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:4460 RED BANK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-271-5111
Practice Address - Fax:513-272-7084
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50-001894363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHL19324871Medicare PIN
OHLYPA20642Medicare PIN
OHP81992Medicare UPIN