Healthcare Provider Details

I. General information

NPI: 1821905035
Provider Name (Legal Business Name): JHADIRA ALEXANDRA SOTO CHIPANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3239 107TH ST STE 1
EAST ELMHURST NY
11369-2396
US

IV. Provider business mailing address

3239 107TH ST STE 1
EAST ELMHURST NY
11369-2396
US

V. Phone/Fax

Practice location:
  • Phone: 347-448-7560
  • Fax:
Mailing address:
  • Phone: 347-448-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: