Provider Demographics
NPI:1306203476
Name:SOTOMAYOR, INDIRA ELISA (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:INDIRA
Middle Name:ELISA
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 GRAND ST APT J707
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2743
Mailing Address - Country:US
Mailing Address - Phone:917-450-5170
Mailing Address - Fax:212-598-4652
Practice Address - Street 1:568 GRAND ST APT J707
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2743
Practice Address - Country:US
Practice Address - Phone:917-450-5170
Practice Address - Fax:212-598-4652
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY866649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist