Provider Demographics
NPI:1245937895
Name:DESALVO, DEMI MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:MARIE
Last Name:DESALVO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7029 AMETHYST LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3401
Mailing Address - Country:US
Mailing Address - Phone:214-457-6168
Mailing Address - Fax:
Practice Address - Street 1:3417 GASTON AVE STE 920
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2035
Practice Address - Country:US
Practice Address - Phone:469-800-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical