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General NPI Number Information
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NPI Number | 1609135300
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Entity Type | Organization
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Legal Business Name | SOORENA SADRI DPM PA
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/27/2020
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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 | 239-590-8860
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Fax | 949-577-4813
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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 | OWNER
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Name | DR. SOORENA SADRI
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Credential | DPM
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Telephone | 239-590-8860
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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 |
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License Number State | FL
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