Healthcare Provider Details

I. General information

NPI: 1164368437
Provider Name (Legal Business Name): MICALA SODE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 N MAIN ST
EAST LONGMEADOW MA
01028-1861
US

IV. Provider business mailing address

448 N MAIN ST
EAST LONGMEADOW MA
01028-1861
US

V. Phone/Fax

Practice location:
  • Phone: 413-303-6132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: