Provider Demographics
NPI:1346326899
Name:SONI, MAHESH M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:M
Last Name:SONI
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 1:1051 PORT MALABAR BLVD NE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5153
Mailing Address - Country:US
Mailing Address - Phone:321-725-3464
Mailing Address - Fax:321-725-6169
Practice Address - Street 1:1051 PORT MALABAR BLVD NE
Practice Address - Street 2:SUITE 9
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5153
Practice Address - Country:US
Practice Address - Phone:321-725-3464
Practice Address - Fax:321-725-6169
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201720Medicaid
FL40462OtherBLUECROSS BLUESHIELD
FL27939Medicaid
FL05567OtherBLUECROSS BLUESHIELD
FL216816Medicaid
FL4038938OtherAETNA
FL216816Medicaid