Healthcare Provider Details

I. General information

NPI: 1336965185
Provider Name (Legal Business Name): SONI FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 MAGUIRE RD
OCOEE FL
34761-4797
US

IV. Provider business mailing address

PO BOX 1568
DAVENPORT FL
33836-1568
US

V. Phone/Fax

Practice location:
  • Phone: 863-588-4775
  • Fax: 863-422-7664
Mailing address:
  • Phone: 863-588-4775
  • Fax: 863-588-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMBICA SONI
Title or Position: OWNER
Credential: MD
Phone: 863-588-4775