Healthcare Provider Details

I. General information

NPI: 1891714549
Provider Name (Legal Business Name): EVELYN SOTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

IV. Provider business mailing address

3 SHARON DR
HIGHLAND NY
12528-2324
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2738
  • Fax: 845-486-2749
Mailing address:
  • Phone: 845-691-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number473849-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: