Provider Demographics
NPI:1982873949
Name:WILLIAM SALCEDO DPM PA
Entity Type:Organization
Organization Name:WILLIAM SALCEDO DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:772-631-3326
Mailing Address - Street 1:1331 S E PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952
Mailing Address - Country:US
Mailing Address - Phone:772-337-0014
Mailing Address - Fax:772-398-0887
Practice Address - Street 1:1331 S E PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-337-0014
Practice Address - Fax:772-398-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2253213ES0131X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390067300Medicaid
FL65266Medicare PIN
FLU40947Medicare UPIN
FL390067300Medicaid