Healthcare Provider Details

I. General information

NPI: 1154559045
Provider Name (Legal Business Name): SREEPADMA PRIYA SONTY M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8875 NW 23RD ST
DORAL FL
33172-2419
US

IV. Provider business mailing address

8875 NW 23RD ST
DORAL FL
33172-2419
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax: 305-653-5513
Mailing address:
  • Phone: 786-389-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number539604
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number28170
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number133687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: