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General NPI Number Information
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NPI Number | 1962140194
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Entity Type | Individual
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Provider Name | SOFIANYELI COLON-REQUEJO PSYD, LP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 601 CARLSON PKWY
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City | MINNETONKA
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State | MN
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Zip | 55305-5203
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 15578 EMPRESS AVE N UNIT 5
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City | HUGO
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State | MN
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Zip | 55038-4620
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Country | US
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Telephone | 787-988-9790
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6831
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP6831
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License Number State | MN
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