Healthcare Provider Details

I. General information

NPI: 1992456701
Provider Name (Legal Business Name): AMY SALLEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 MISSION ST
SAN FRANCISCO CA
94103-2543
US

IV. Provider business mailing address

1563 MISSION ST
SAN FRANCISCO CA
94103-2543
US

V. Phone/Fax

Practice location:
  • Phone: 800-200-7181
  • Fax: 415-746-1941
Mailing address:
  • Phone: 800-200-7181
  • Fax: 415-746-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95030585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: