Provider Demographics
NPI:1558182808
Name:SOTO, KEYLA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:KEYLA
Middle Name:MICHELLE
Last Name:SOTO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WHITEHOUSE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-5343
Mailing Address - Country:US
Mailing Address - Phone:585-568-9372
Mailing Address - Fax:
Practice Address - Street 1:79 WHITEHOUSE DR APT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-5343
Practice Address - Country:US
Practice Address - Phone:585-568-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35159001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse