Provider Demographics
NPI:1003421553
Name:ELIGIO, CRISTY SORAIDA
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:SORAIDA
Last Name:ELIGIO
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 1:250 WALTON AVE STE 2N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5416
Mailing Address - Country:US
Mailing Address - Phone:646-798-0756
Mailing Address - Fax:
Practice Address - Street 1:250 WALTON AVE STE 2N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5416
Practice Address - Country:US
Practice Address - Phone:646-798-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional