MEDICARE: DR. SOORENA SADRI DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC006138	PA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3565	FL

General Provider Information

NPI Number	:	1578792339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOORENA SADRI DPM

Provider Business Mailing Address
First Line	:	4956 ROYAL GULF CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7006
Country	:	US
Telephone Number	:	239-590-8860
Fax Number	:	949-577-4813

Provider Business Practice Location Address
First Line	:	4956 ROYAL GULF CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7006
Country	:	US
Telephone Number	:	239-850-2736
Fax Number	:

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	12/30/2022

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