Healthcare Provider Details

I. General information

NPI: 1194916999
Provider Name (Legal Business Name): SONUL MEHTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/16/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD WEST PAVILION, 3RD FLOOR
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

51 N 39TH ST SCHEIE EYE INSTITUTE
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 215-614-4100
  • Fax: 215-615-0527
Mailing address:
  • Phone: 215-614-4100
  • Fax: 215-615-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD449498
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: