Provider Demographics
NPI:1225527583
Name:HENRIQUEZ, SALATNAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SALATNAY
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 79TH STREET CSWY STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4197
Mailing Address - Country:US
Mailing Address - Phone:305-726-2177
Mailing Address - Fax:
Practice Address - Street 1:1700 79TH STREET CSWY STE 120
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4197
Practice Address - Country:US
Practice Address - Phone:305-726-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1179208D00000X
390200000X
FLME160439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program