Provider Demographics
NPI:1114191079
Name:SONI, AMBICA (MD)
Entity type:Individual
Prefix:DR
First Name:AMBICA
Middle Name:
Last Name:SONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:106 PARK PLACE BLVD STE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6868
Practice Address - Country:US
Practice Address - Phone:863-588-4775
Practice Address - Fax:863-422-7664
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247497207Q00000X
390200000X
FLME115157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program