Provider Demographics
NPI:1558077917
Name:SOARES, STACI VICTORIA (HHP, CWHC, HNP, ETC)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:VICTORIA
Last Name:SOARES
Suffix:
Gender:F
Credentials:HHP, CWHC, HNP, ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 WEBSTER AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5041
Mailing Address - Country:US
Mailing Address - Phone:530-487-0575
Mailing Address - Fax:
Practice Address - Street 1:3560 WEBSTER AVE APT 6A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5041
Practice Address - Country:US
Practice Address - Phone:530-487-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
OR171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty