Provider Demographics
NPI:1508960881
Name:SONI, NEHA N (MD)
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:N
Last Name:SONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:H
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5139 JIMMY CARTER BLVD
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1680
Mailing Address - Country:US
Mailing Address - Phone:678-248-2350
Mailing Address - Fax:678-404-8435
Practice Address - Street 1:5139 JIMMY CARTER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1638
Practice Address - Country:US
Practice Address - Phone:678-248-2350
Practice Address - Fax:678-404-8435
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229818208000000X
NJ25MA07620400208000000X
GA060096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA275137652CMedicaid