Provider Demographics
NPI:1083143341
Name:CARBALLO SALAZAR, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CARBALLO SALAZAR
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 1:8181 NW S RIVER DR LOT A139
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7457
Mailing Address - Country:US
Mailing Address - Phone:786-414-4973
Mailing Address - Fax:
Practice Address - Street 1:8181 NW S RIVER DR LOT A 139
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:786-414-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst