Provider Demographics
NPI:1134371362
Name:SALERNO, MICHELLE ANNE (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:SALERNO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SCHOLAR PL
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1085
Mailing Address - Country:US
Mailing Address - Phone:631-675-0298
Mailing Address - Fax:
Practice Address - Street 1:10 SCHOLAR PL
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1085
Practice Address - Country:US
Practice Address - Phone:631-675-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351491163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY351491Medicaid