Healthcare Provider Details

I. General information

NPI: 1770963423
Provider Name (Legal Business Name): SONIA BHANDARI RANDHAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST ROOM 7150
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

245 N 15TH ST RM 7150
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-3585
  • Fax: 215-762-3058
Mailing address:
  • Phone: 215-762-3585
  • Fax: 215-762-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT208667
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberT5831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: