MEDICARE: SOROYA WATSON RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	R240815	MD

General Provider Information

NPI Number	:	1518898196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOROYA WATSON RN, IBCLC

Provider Business Mailing Address
First Line	:	7611 CRAIN HWY STE C150
Second Line	:	UNIT 520
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772
Country	:	US
Telephone Number	:	631-561-7580
Fax Number	:

Provider Business Practice Location Address
First Line	:	7611 CRAIN HWY STE C150
Second Line	:	UNIT 520
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772
Country	:	US
Telephone Number	:	631-561-7580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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