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NPI Code Detail

MEDICARE: MICHELLE MARIE CORDERO-SOTO PH.D.

MEDICARE: MICHELLE MARIE CORDERO-SOTO PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY10329FL
2103TC0700XClinical PsychologistPY10329FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689007734
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MARIE CORDERO-SOTO PH.D.
Provider Business Mailing Address
First Line : 5510 N HESPERIDES ST
Second Line :
City : TAMPA
State : FL
Zip : 33614-5414
Country : US
Telephone Number : 813-467-6111
Fax Number : 813-467-6013
Provider Business Practice Location Address
First Line : 4700 MILLENIA BLVD STE 500
Second Line :
City : ORLANDO
State : FL
Zip : 32839-6019
Country : US
Telephone Number : 813-467-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2013
Last Update Date : 01/26/2024

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