Healthcare Provider Details

I. General information

NPI: 1548199334
Provider Name (Legal Business Name): SOFIA LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAGE LUNA

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BELDEN AVE STE 4
NORWALK CT
06850-3314
US

IV. Provider business mailing address

33 COMMONWEALTH DR
FAIRFIELD CT
06824-7826
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-8161
  • Fax: 203-580-8319
Mailing address:
  • Phone: 786-510-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: