Provider Demographics
NPI:1740828847
Name:SODT, EVELINA (PHD)
Entity type:Individual
Prefix:DR
First Name:EVELINA
Middle Name:
Last Name:SODT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MILTON CT
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-1248
Mailing Address - Country:US
Mailing Address - Phone:845-244-0679
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1346
Practice Address - Country:US
Practice Address - Phone:845-244-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ32WC00564900OtherLICENSE