Provider Demographics
NPI:1699106658
Name:EMEAGWALI, SONYA AMELIA (CRNA)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:AMELIA
Last Name:EMEAGWALI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:AMELIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1851
Practice Address - Country:US
Practice Address - Phone:718-604-5456
Practice Address - Fax:718-604-5571
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555267163WC0200X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine