Healthcare Provider Details

I. General information

NPI: 1720305030
Provider Name (Legal Business Name): SONIA SINGH GREVENITIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 PADGETT SWITCH RD
IRVINGTON AL
36544-4011
US

IV. Provider business mailing address

12701 PADGETT SWITCH RD
IRVINGTON AL
36544-4011
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-2174
  • Fax:
Mailing address:
  • Phone: 251-824-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD35420
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: