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NPI Code Detail

MEDICARE: SHADI SALLIT M.D.

MEDICARE: SHADI SALLIT M.D.
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
1207RN0300XNephrology Physician278462-1NY
2207RN0300XNephrology Physician35.135411OH
3207RN0300XNephrology PhysicianMD452285PA

General Provider Information

NPI Number : 1477843688
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHADI SALLIT M.D.
Provider Business Mailing Address
First Line : PO BOX 416170
Second Line :
City : BOSTON
State : MA
Zip : 02241-6170
Country : US
Telephone Number : 610-644-8900
Fax Number : 610-771-4225
Provider Business Practice Location Address
First Line : 7959 BUSTLETON AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19152-3320
Country : US
Telephone Number : 215-742-5662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2011
Last Update Date : 04/18/2023

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