Provider Demographics
NPI:1720206352
Name:SALERNO, MARY L (PHD, NP, APRN-BC)
Entity Type:Individual
Prefix:PROF
First Name:MARY
Middle Name:L
Last Name:SALERNO
Suffix:
Gender:F
Credentials:PHD, NP, APRN-BC
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:SALERNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, NP, APRN-BC
Mailing Address - Street 1:1007 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-1708
Mailing Address - Country:US
Mailing Address - Phone:315-422-2623
Mailing Address - Fax:
Practice Address - Street 1:1007 COURT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-1708
Practice Address - Country:US
Practice Address - Phone:315-422-2623
Practice Address - Fax:315-634-7023
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN38101363LA2200X
NY30306432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health