Healthcare Provider Details

I. General information

NPI: 1356604755
Provider Name (Legal Business Name): SOPHIA A ABDULHAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPHIA ABDULRAZZAK ABDULHAI MD

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

615 E 12TH ST
WASHINGTON NC
27889-3408
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2025-01887
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number184984
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01088681A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number01088681A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.128467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: