Healthcare Provider Details

I. General information

NPI: 1497048938
Provider Name (Legal Business Name): SONITA KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10129 CLEAR VISTA ST
ORLANDO FL
32832-7164
US

IV. Provider business mailing address

1301 HODGES DR
TALLAHASSEE FL
32308-4614
US

V. Phone/Fax

Practice location:
  • Phone: 833-663-6331
  • Fax: 833-673-0418
Mailing address:
  • Phone: 850-431-5741
  • Fax: 850-431-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTRN15874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: