Provider Demographics
NPI:1699702894
Name:SHANLEY, SONJA MAIA (MD)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:MAIA
Last Name:SHANLEY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1410 COMMONWEALTH DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0376
Mailing Address - Country:US
Mailing Address - Phone:910-679-4784
Mailing Address - Fax:910-777-5453
Practice Address - Street 1:1410 COMMONWEALTH DR
Practice Address - Street 2:STE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0376
Practice Address - Country:US
Practice Address - Phone:910-679-4784
Practice Address - Fax:910-777-5453
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-07-19
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Provider Licenses
StateLicense IDTaxonomies
NC9701146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891056XMedicaid
NC891056XMedicaid