Individual provider Active NPI

Sofianyeli Colon-Requejo, PSYD, LP

  • Clinical Psychologist
  • Minnetonka, MN
National Provider Identifier
1962140194
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP6831 Issued in MN
Practice address
601 Carlson Pkwy
Minnetonka, MN 55305-5203
Phone
(323) 205-7088
NPI assigned
May 26, 2022
Last updated
May 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP6831 MN Primary
Psychologist 103T00000X LP6831 MN

Addresses

Primary practice location

601 Carlson Pkwy
Minnetonka, MN 55305-5203

Mailing address

15578 Empress Ave N Unit 5
Hugo, MN 55038-4620
Phone (787) 988-9790

Other practice location 1

15251 Pleasant Valley Rd
Center City, MN 55012-9640
Phone (651) 213-4120

Other practice location 2

680 Stewart Ave
Saint Paul, MN 55102-4117
Phone (651) 312-3070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LP6831MNMDPsychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1962140194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15578 EMPRESS AVE N UNIT 5",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550384620",
            "telephone_number": "787-988-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CARLSON PKWY",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055203",
            "telephone_number": "323-205-7088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15251 Pleasant Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Center City",
            "state": "MN",
            "postal_code": "550129640",
            "country_code": "US",
            "telephone_number": "651-213-4120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "680 Stewart Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551024117",
            "country_code": "US",
            "telephone_number": "651-312-3070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLON-REQUEJO",
        "first_name": "SOFIANYELI",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-26",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6831",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6831",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.