An ultrasonic sensor pixel includes a substrate, a piezoelectric micromechanical ultrasonic transducer (PMUT) and a sensor pixel circuit. The PMUT includes a piezoelectric layer stack including a piezoelectric layer disposed over a cavity, the cavity being disposed between the piezoelectric layer stack and the substrate, a reference electrode disposed between the piezoelectric layer and the cavity, and one or both of a receive electrode and a transmit electrode disposed on or proximate to a first surface of the piezoelectric layer, the first surface being opposite from the cavity. The sensor pixel circuit is electrically coupled with one or more of the reference electrode, the receive electrode and the transmit electrode and the PMUT and the sensor pixel circuit are integrated with the sensor pixel circuit on the substrate.