Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD438123 | PA |
NPI | 1124217971 |
---|---|
Provider Name | Sonyo Shin |
First Address | East Stroudsburg, PA 18301-3006 |
Second Address | East Stroudsburg, PA 18301-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1024112130001 | (05) | PA |
3749708000 | INDEPENDENCE BLUE CROSS (01) | PA |
50089273 | CAPITAL BLUE CROSS (01) | PA |