Provider Demographics
NPI:1164784245
Name:SOTO, YUDELKA ALTAGRACIA (MS/SE)
Entity Type:Individual
Prefix:MRS
First Name:YUDELKA
Middle Name:ALTAGRACIA
Last Name:SOTO
Suffix:
Gender:F
Credentials:MS/SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 143RD ST
Mailing Address - Street 2:APT. #5-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-3529
Mailing Address - Country:US
Mailing Address - Phone:212-283-9705
Mailing Address - Fax:212-283-9705
Practice Address - Street 1:111 LIVINGSTON ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5078
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:718-625-4702
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586833051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist