Provider Demographics
NPI:1831128958
Name:SALAS, AMANDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:B
Last Name:SALAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-1090
Mailing Address - Country:US
Mailing Address - Phone:843-525-0500
Mailing Address - Fax:
Practice Address - Street 1:32 NEWPOINT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-2044
Practice Address - Country:US
Practice Address - Phone:843-525-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA555192084P0800X
SC274802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC274802Medicaid
SCI232243353Medicare PIN
SCI232243361Medicare PIN
SCI23224Medicare UPIN
SCI232243353Medicare ID - Type Unspecified
SC274802Medicaid