Healthcare Provider Details

I. General information

NPI: 1992709679
Provider Name (Legal Business Name): SONYA S SAADATI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONYA MARDEN

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 SUNSET BLVD N STE 208
SUNSET BEACH NC
28468-5611
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 910-575-8488
  • Fax: 910-575-6542
Mailing address:
  • Phone: 910-575-8488
  • Fax: 910-575-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1213
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-02209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: