Healthcare Provider Details

I. General information

NPI: 1275648255
Provider Name (Legal Business Name): SONAL G GOSWAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DEERWOOD LAKE PKWY STE 101-232
JACKSONVILLE FL
32216-1177
US

IV. Provider business mailing address

8312 HEDGEWOOD DR
JACKSONVILLE FL
32216-1489
US

V. Phone/Fax

Practice location:
  • Phone: 904-513-8747
  • Fax:
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME88364
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number104762
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME88364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: