Provider Demographics
NPI:1588331664
Name:SIDLE, SONIA (FNTP)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:SIDLE
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:TRAUMANN
Other - Last Name:SIDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNTP
Mailing Address - Street 1:11274 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-9663
Mailing Address - Country:US
Mailing Address - Phone:970-214-5213
Mailing Address - Fax:
Practice Address - Street 1:11274 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-9663
Practice Address - Country:US
Practice Address - Phone:970-214-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date: