Provider Demographics
NPI:1962735100
Name:SONNY JOSEPH MD PLLC
Entity type:Organization
Organization Name:SONNY JOSEPH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-354-5290
Mailing Address - Street 1:9430 TURKEY LAKE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8015
Mailing Address - Country:US
Mailing Address - Phone:407-354-5290
Mailing Address - Fax:407-354-5290
Practice Address - Street 1:9430 TURKEY LAKE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8015
Practice Address - Country:US
Practice Address - Phone:407-354-5290
Practice Address - Fax:407-370-3411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONNY JOSEPH MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00576632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE58549Medicare UPIN