Provider Demographics
NPI:1770182966
Name:SALGADO, MAITELYN SR (BS)
Entity Type:Individual
Prefix:
First Name:MAITELYN
Middle Name:
Last Name:SALGADO
Suffix:SR
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 NW CENTRAL PARK PLZ STE 104
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2482
Mailing Address - Country:US
Mailing Address - Phone:772-672-0897
Mailing Address - Fax:
Practice Address - Street 1:145 NW CENTRAL PARK PLZ STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2482
Practice Address - Country:US
Practice Address - Phone:772-672-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency