Healthcare Provider Details

I. General information

NPI: 1841201753
Provider Name (Legal Business Name): OLUYEMISI ADEOLA SONOIKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 3RD ST STE 106
ROCKLEDGE FL
32955-5751
US

IV. Provider business mailing address

6525 3RD ST STE 106
ROCKLEDGE FL
32955-5751
US

V. Phone/Fax

Practice location:
  • Phone: 321-307-9400
  • Fax: 321-622-3036
Mailing address:
  • Phone: 321-307-9400
  • Fax: 321-622-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94933
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME94933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: