Provider Demographics
NPI:1134667090
Name:SALAZAR, CLAUDIA PATRICIA (PA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:PATRICIA
Last Name:SALAZAR
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:PATRICIA
Other - Last Name:PANIQUITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:20 BOWMAN LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2007
Mailing Address - Country:US
Mailing Address - Phone:631-897-6650
Mailing Address - Fax:631-957-4619
Practice Address - Street 1:820 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4498
Practice Address - Country:US
Practice Address - Phone:631-957-2200
Practice Address - Fax:631-957-4619
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020401-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical