MEDICARE: KEISHLA MAYRIM CANCEL SOTO

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	172V00000X	Community Health Worker	23639	PA

General Provider Information

NPI Number	:	1760310502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHLA MAYRIM CANCEL SOTO

Provider Business Mailing Address
First Line	:	450 CHEW ST STE 203
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18102-3434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 CHEW ST STE 203
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18102-3434
Country	:	US
Telephone Number	:	484-225-6840
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ KEISHLA MAYRIM CANCEL SOTO ” Practice Location

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