Healthcare Provider Details

I. General information

NPI: 1154825305
Provider Name (Legal Business Name): SONIA SHASTRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 AAA BLVD STE C
NEWARK DE
19713-3624
US

IV. Provider business mailing address

875 AAA BLVD STE C
NEWARK DE
19713-3624
US

V. Phone/Fax

Practice location:
  • Phone: 302-918-6400
  • Fax:
Mailing address:
  • Phone: 302-918-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2-0023911
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: