Provider Demographics
NPI:1376591099
Name:SOTO, ROSE D (NP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:D
Last Name:SOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:DAOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-5016
Mailing Address - Fax:315-464-7328
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-5016
Practice Address - Fax:315-464-5355
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303339363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q17055Medicare UPIN
NYRB0214Medicare PIN