Healthcare Provider Details

I. General information

NPI: 1316567217
Provider Name (Legal Business Name): AMANDA SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

IV. Provider business mailing address

6087 DECATUR BLVD.
INDIANAPOLIS IN
46241
US

V. Phone/Fax

Practice location:
  • Phone: 317-813-4690
  • Fax:
Mailing address:
  • Phone: 317-813-4690
  • Fax: 888-498-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: