Healthcare Provider Details

I. General information

NPI: 1508507542
Provider Name (Legal Business Name): VICTORIA SONCASIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 CLAYTON AVE
SAINT LOUIS MO
63110-1501
US

IV. Provider business mailing address

4523 CLAYTON AVE
SAINT LOUIS MO
63110-1501
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1700
  • Fax: 314-362-9878
Mailing address:
  • Phone: 314-362-1700
  • Fax: 314-362-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2026012501
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026012501
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: