Basic Information
| Provider Information | |||||||||
| NPI: | 1043827413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAMOOZADEH | ||||||||
| FirstName: | SONYA | ||||||||
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| Credential: | DNP, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 COMET DR | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285169792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436856745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 302 MEDICAL PARK CT | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285574346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522472013 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2020 | ||||||||
| LastUpdateDate: | 10/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5013620 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.