Provider Demographics
NPI:1396338455
Name:SOTOMAYOR, T'ONA MO'NIEKE (CCHW, CBS)
Entity type:Individual
Prefix:MRS
First Name:T'ONA
Middle Name:MO'NIEKE
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:CCHW, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06607-1404
Mailing Address - Country:US
Mailing Address - Phone:203-400-9996
Mailing Address - Fax:
Practice Address - Street 1:450 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06607-1404
Practice Address - Country:US
Practice Address - Phone:203-400-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT172V00000X
CT3B95F76112174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No172V00000XOther Service ProvidersCommunity Health Worker