Provider Demographics
NPI:1477897700
Name:SALVAS, CANDICE M (PA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:M
Last Name:SALVAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:718 SMYTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-7007
Mailing Address - Country:US
Mailing Address - Phone:603-624-4366
Mailing Address - Fax:
Practice Address - Street 1:718 SMYTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-7007
Practice Address - Country:US
Practice Address - Phone:603-624-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0928363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical