Provider Demographics
NPI:1275980559
Name:DEMORO, SALVATORE JEREMY
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:JEREMY
Last Name:DEMORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1675
Mailing Address - Country:US
Mailing Address - Phone:417-208-5760
Mailing Address - Fax:417-208-5960
Practice Address - Street 1:420 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1675
Practice Address - Country:US
Practice Address - Phone:417-208-5760
Practice Address - Fax:417-208-5960
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1619237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist