"Sexually Violent Predator" status requires lifetime registration, lifetime mandatory sex offender counseling with a treatment provider and notification of the community that a "sexually violent predator" lives in the area.
O'Neill also made a decision to designate Cosby a "sexually violent predator" under Pennsylvania law.
Prosecutors had asked the judge on Monday to sentence Cosby to five to 10 years in state prison for the assault, saying he had shown "no remorse" for his actions.
Bill Cosby refrained from peering at the camera in his glum-looking mug shot, which was taken just minutes after he was sentenced to 3-10 years in prison on September 25. His defense requested that he be able to serve his term on house arrest instead of prison, considering he's old and blind and a celebrity, but the judge said, in so many words: Hell no. Prison for you.
A prosecutor says Bill Cosby has been "unmasked" as a predator now that he's been convicted and sentenced to prison for sexually assaulting a woman in 2004.
Cosby's first trial in 2017 ended in a mistrial when jurors could not reach a verdict.
Montgomery County Judge Steven O'Neill said during sentencing: "It is time for justice".
Throughout the nearly two-day sentencing, the prosecution reiterated Cosby's crimes and what they call his "predatory" nature: "He violated Ms. Constand's trust, which, unbeknownst to her, he spent time and energy cultivating with the specific intent of having sexual contact with her".
Bill Cosby's spokesman Andrew Wyatt said outside a Pennsylvania courtroom Tuesday: "Mr Cosby knows that God is watching over him. he knows that these are lies".
During victim impact statements on Monday, Constand's mother told the court that her family feels vindicated.
A judge has ruled that Bill Cosby is a "sexually violent predator".
His lawyers have already vowed to appeal the conviction.
Montgomery County District Attorney Kevin Steele rejected the call for a softer punishment. O'Neill allowed five of them to testify at trial, while others came to watch the court proceedings.
In a statement submitted to the court and released on Tuesday, Constand, 45, said she had to cope with years of anxiety and self-doubt.
Ms Constand wrote that Cosby's 2004 attack on her was just "the tip of the iceberg" for the suffering that followed. "So it's taken a long time to get there", Steele said.
"I wanted 30 years but I'm very happy to know that Mr Cosby will do time in prison", said Chelan Lasha, one of his accusers who testified at trial.
Defense attorney Joseph Green started the second day of Cosby's sentencing hearing by getting a psychologist for the state to acknowledge it's possible Cosby is in "full remission" from a psychological disorder she says gives him the uncontrollable urge to assault women.