Healthcare Provider Details

I. General information

NPI: 1720993207
Provider Name (Legal Business Name): SARAH JAQUA SOTO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13991 STONEY CREEK DR
NORTH ROYALTON OH
44133-4114
US

IV. Provider business mailing address

13991 STONEY CREEK DR
NORTH ROYALTON OH
44133-4114
US

V. Phone/Fax

Practice location:
  • Phone: 330-808-3078
  • Fax:
Mailing address:
  • Phone: 330-808-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0042704
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: