Provider Demographics
NPI:1881401578
Name:SALT AND LIGHT WELLNESS PLLC
Entity type:Organization
Organization Name:SALT AND LIGHT WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALLERIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:845-857-7820
Mailing Address - Street 1:61 ARROW RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1301
Mailing Address - Country:US
Mailing Address - Phone:860-851-3545
Mailing Address - Fax:860-266-1127
Practice Address - Street 1:61 ARROW RD STE 103
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1301
Practice Address - Country:US
Practice Address - Phone:860-851-3545
Practice Address - Fax:860-266-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service