Provider Demographics
NPI:1821775115
Name:SALAZAR, SARAH S
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:S
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 CASON COVE DR APT 414
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6379
Mailing Address - Country:US
Mailing Address - Phone:407-548-4965
Mailing Address - Fax:
Practice Address - Street 1:4925 CASON COVE DR APT 414
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-6379
Practice Address - Country:US
Practice Address - Phone:407-548-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician