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General NPI Number Information
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NPI Number | 1912699877
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Entity Type | Individual
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Provider Name | SHANIQUE OMEALLY-SOTO NP
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 25-10 30TH AVE
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City | ASTORIA
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State | NY
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Zip | 11102-2448
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Country | US
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Telephone | 718-932-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3470 FORT INDEPENDENCE ST APT 5D
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City | BRONX
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State | NY
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Zip | 10463-4593
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Country | US
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Telephone | 917-470-4678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F310558
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License Number State | NY
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