Healthcare Provider Details

I. General information

NPI: 1740552462
Provider Name (Legal Business Name): COURTNEY SALAMONE DOM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 NE 3RD ST
BOYNTON BEACH FL
33435-3847
US

IV. Provider business mailing address

1010 NE 8TH AVE APT 35
DELRAY BEACH FL
33483-5853
US

V. Phone/Fax

Practice location:
  • Phone: 561-862-8948
  • Fax:
Mailing address:
  • Phone: 561-862-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP 2308
License Number StateFL

VIII. Authorized Official

Name: COURTNEY SALAMONE
Title or Position: OWNER
Credential: DOM
Phone: 561-862-8948