Provider Demographics
NPI:1447561816
Name:SALVETTI, CHRISTINA ELISE (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELISE
Last Name:SALVETTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ELISE
Other - Last Name:ZAIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-723-2845
Mailing Address - Fax:585-723-6877
Practice Address - Street 1:183 INTREPID LANE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205
Practice Address - Country:US
Practice Address - Phone:315-251-0401
Practice Address - Fax:315-251-0405
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0800363A00000X
NY015746363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03494135Medicaid
NYJ400076639Medicare PIN