Provider Demographics
NPI:1972398261
Name:PITTALWALA, SONYA PREMA
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:PREMA
Last Name:PITTALWALA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 NOSTRAND AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4799
Mailing Address - Country:US
Mailing Address - Phone:917-728-7850
Mailing Address - Fax:
Practice Address - Street 1:1365 NOSTRAND AVE APT 7B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4799
Practice Address - Country:US
Practice Address - Phone:917-728-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health