Healthcare Provider Details

I. General information

NPI: 1902734700
Provider Name (Legal Business Name): SOPHIA JAGDISH BHALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MANNING DR
CHAPEL HILL NC
27514-4221
US

IV. Provider business mailing address

170 MANNING DR
CHAPEL HILL NC
27514-4221
US

V. Phone/Fax

Practice location:
  • Phone: 919-843-9014
  • Fax: 919-966-0098
Mailing address:
  • Phone: 919-843-9014
  • Fax: 919-966-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: