Provider Demographics
NPI:1841954450
Name:SALO, LINDSAY M
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:M
Last Name:SALO
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 1:213 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2903
Mailing Address - Country:US
Mailing Address - Phone:315-416-7033
Mailing Address - Fax:
Practice Address - Street 1:5962 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8800
Practice Address - Country:US
Practice Address - Phone:315-698-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1142199Medicaid