Provider Demographics
NPI:1235419193
Name:DAVIS, SOPHIA PEREIRA (DO)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:PEREIRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W CRYSTAL LAKE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4476
Mailing Address - Country:US
Mailing Address - Phone:407-254-2500
Mailing Address - Fax:407-423-2789
Practice Address - Street 1:25 W CRYSTAL LAKE ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4476
Practice Address - Country:US
Practice Address - Phone:407-254-2500
Practice Address - Fax:407-423-2789
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15488207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty