Provider Demographics
NPI:1992709679
Name:SAADATI, SONYA S (DO)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:S
Last Name:SAADATI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:
Other - Last Name:MARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:910-575-8488
Mailing Address - Fax:910-575-6542
Practice Address - Street 1:690 SUNSET BLVD N STE 208
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-5611
Practice Address - Country:US
Practice Address - Phone:910-575-8488
Practice Address - Fax:910-575-6542
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1213207Q00000X
NC2021-02209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3305106Medicaid
SCQ01218Medicaid