Provider Demographics
NPI:1326212689
Name:MEHTA, SONAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SONAL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 CENTRAL PARK BLVD N STE 400
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1705
Mailing Address - Country:US
Mailing Address - Phone:561-288-5500
Mailing Address - Fax:561-482-1469
Practice Address - Street 1:1190 NW 95TH ST STE 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2067
Practice Address - Country:US
Practice Address - Phone:786-502-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053780207R00000X
SC37165207R00000X
SCMD371652084V0102X, 2084V0102X
FLME1339312084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2084N0400XOtherTAXONOMY
SC371653Medicaid