MEDICARE: SONAM BANSAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN25757	FL

General Provider Information

NPI Number	:	1518576933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONAM BANSAL

Provider Business Mailing Address
First Line	:	12368 STATE ROAD 535
Second Line	:	#249
City	:	ORLANDO
State	:	FL
Zip	:	32836
Country	:	US
Telephone Number	:	773-899-2917
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N SEMORAN BLVD STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3381
Country	:	US
Telephone Number	:	407-277-6272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	08/19/2025

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Directions to “ SONAM BANSAL ” Practice Location

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