Individual
DR. SONYA ANN SHIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
(260) 432-8414
(260) 432-2250
Mailing address
4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
(260) 432-8414
(260) 432-2250
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010188A
IN
Other
Enumeration date
09/11/2011
Last updated
09/11/2011
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