Provider Demographics
NPI:1114329273
Name:SOOD, NEELAM RAUTELA
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:RAUTELA
Last Name:SOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 HOOPER AVE # 2
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8319
Mailing Address - Country:US
Mailing Address - Phone:732-228-4146
Mailing Address - Fax:
Practice Address - Street 1:970 HOOPER AVE # 2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8319
Practice Address - Country:US
Practice Address - Phone:732-228-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22694200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner