Provider Demographics
NPI:1487182390
Name:PALACIO, SORI (MS ED, ITDS)
Entity Type:Individual
Prefix:MS
First Name:SORI
Middle Name:
Last Name:PALACIO
Suffix:
Gender:F
Credentials:MS ED, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 SW 193RD TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8959
Mailing Address - Country:US
Mailing Address - Phone:917-887-5387
Mailing Address - Fax:
Practice Address - Street 1:8760 SW 193RD TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8959
Practice Address - Country:US
Practice Address - Phone:917-887-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1215697174400000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist