Healthcare Provider Details

I. General information

NPI: 1649955832
Provider Name (Legal Business Name): SOFIIA SONINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 12/19/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD SSM HEALTH ST. MARY'S HOSPITAL, DEPARTMENT OF INTERNAL
SAINT LOUIS MO
63117
US

IV. Provider business mailing address

6420 CLAYTON RD SSM HEALTH ST. MARY'S HOSPITAL, DEPARTMENT OF INTERNAL
SAINT LOUIS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2023019405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: