Provider Demographics
NPI:1770017915
Name:SOTO, SIOBHAN
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIOBHAN
Other - Middle Name:TIFFANY
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9605 NW 49TH PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2452
Mailing Address - Country:US
Mailing Address - Phone:407-319-0642
Mailing Address - Fax:
Practice Address - Street 1:9605 NW 49TH PL
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2452
Practice Address - Country:US
Practice Address - Phone:407-319-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician