Provider Demographics
NPI:1689853111
Name:SANGHVI, SONAL A (PA-C)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:A
Last Name:SANGHVI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SONAL
Other - Middle Name:A
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1236 E RUSHOLME ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2434
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-888-0499
Practice Address - Street 1:350 JOHN DEERE RD
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6899
Practice Address - Country:US
Practice Address - Phone:309-743-6700
Practice Address - Fax:309-743-6709
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001859363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001859OtherPA LICENSE NUMBER
IL42106072402OtherMEDICARE GROUP
CP8565OtherRR MEDICARE GROUP
IA13238OtherMEDICARE PART B GROUP
IA13238OtherBCBS GROUP
IA0080200OtherMEDICAID GROUP
IA5101108OtherCSC RIVER DRIVE
IL8122859OtherBCBS GROUP
IA16-1801OtherMEDICARE NGS GROUP
IA16D0387805OtherCLIA RIVER DRIVE