MEDICARE: MR. DAVID ERIC ERVAST-SALMON MM, MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor
2	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1013883966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ERIC ERVAST-SALMON MM, MT-BC

Provider Business Mailing Address
First Line	:	2460 CONWAY RD APT 74
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-4539
Country	:	US
Telephone Number	:	850-273-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 CONWAY RD APT 74
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-4539
Country	:	US
Telephone Number	:	850-273-9501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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