Provider Demographics
NPI:1275225971
Name:SALGADO SOTO, SHALIAM NICOLE (M S CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHALIAM
Middle Name:NICOLE
Last Name:SALGADO SOTO
Suffix:
Gender:F
Credentials:M S CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 SE ANCHORAGE CV APT C-2
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6216
Mailing Address - Country:US
Mailing Address - Phone:787-565-2243
Mailing Address - Fax:
Practice Address - Street 1:2512 SE ANCHORAGE CV APT C-2
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6216
Practice Address - Country:US
Practice Address - Phone:787-565-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist