Provider Demographics
NPI:1073922894
Name:SOLDANO, JULIA (MA, CLC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SOLDANO
Suffix:
Gender:F
Credentials:MA, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782
Mailing Address - Country:US
Mailing Address - Phone:631-678-3162
Mailing Address - Fax:
Practice Address - Street 1:4 ROSE STREET
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782
Practice Address - Country:US
Practice Address - Phone:631-678-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN