Provider Demographics
NPI:1053367441
Name:BAHROO, SONIA LAXMAN (PA-C)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:LAXMAN
Last Name:BAHROO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:SHAMDASANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5801 ALLENTOWN RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4518
Mailing Address - Country:US
Mailing Address - Phone:202-741-3333
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-3333
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant