Provider Demographics
NPI:1053880708
Name:SODANO, RACHEL JULIA
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JULIA
Last Name:SODANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SPARROW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-3206
Mailing Address - Country:US
Mailing Address - Phone:516-884-5888
Mailing Address - Fax:
Practice Address - Street 1:150 W END AVE APT 1M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5715
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:800-655-3780
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist