Provider Demographics
NPI:1356976229
Name:SOTOMANGO, E ANDREW LEYCO (PA-C)
Entity type:Individual
Prefix:MR
First Name:E ANDREW
Middle Name:LEYCO
Last Name:SOTOMANGO
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2895 HAMILTON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6172
Mailing Address - Country:US
Mailing Address - Phone:610-841-3422
Mailing Address - Fax:610-841-3652
Practice Address - Street 1:2895 HAMILTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6172
Practice Address - Country:US
Practice Address - Phone:610-841-3422
Practice Address - Fax:610-841-3652
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA061186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant