Provider Demographics
NPI:1912364886
Name:VELEZ-SOTO, CHASTITY
Entity Type:Individual
Prefix:MRS
First Name:CHASTITY
Middle Name:
Last Name:VELEZ-SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 SE WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2672
Mailing Address - Country:US
Mailing Address - Phone:772-708-0454
Mailing Address - Fax:
Practice Address - Street 1:702 SE WHITE AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2672
Practice Address - Country:US
Practice Address - Phone:772-708-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator