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General NPI Number Information
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NPI Number | 1578792339
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Entity Type | Individual
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Provider Name | SOORENA SADRI DPM
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Gender | Male
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 4956 ROYAL GULF CIR
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City | FORT MYERS
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State | FL
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Zip | 33966-7006
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Country | US
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Telephone | 239-850-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 4956 ROYAL GULF CIR
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City | FORT MYERS
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State | FL
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Zip | 33966-7006
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Country | US
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Telephone | 239-590-8860
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Fax | 949-577-4813
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC006138
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3565
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License Number State | FL
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