Healthcare Provider Details

I. General information

NPI: 1841085636
Provider Name (Legal Business Name): SALOME D SALLET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 MANATEE AVE W
BRADENTON FL
34205
US

IV. Provider business mailing address

101 RIVERFRONT BLVD SUITE 710
BRADENTON FL
34205
US

V. Phone/Fax

Practice location:
  • Phone: 941-714-7150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11038846
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: