Provider Demographics
NPI:1437414158
Name:MODUGNO, SALENA MARIE (BA)
Entity Type:Individual
Prefix:MS
First Name:SALENA
Middle Name:MARIE
Last Name:MODUGNO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4123
Mailing Address - Country:US
Mailing Address - Phone:347-831-1247
Mailing Address - Fax:
Practice Address - Street 1:1323 E 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4123
Practice Address - Country:US
Practice Address - Phone:347-831-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1929274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist