MEDICARE: DAYRA LIZ SOSTRE SOLIS DC

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	111N00000X	Chiropractor	CH13294	FL

General Provider Information

NPI Number	:	1780287219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYRA LIZ SOSTRE SOLIS DC

Provider Business Mailing Address
First Line	:	4483 BLUE ROCK DR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-9658
Country	:	US
Telephone Number	:	939-257-1023
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E LAKE MARY BLVD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32773-7111
Country	:	US
Telephone Number	:	407-942-3258
Fax Number	:	407-942-3316

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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