Healthcare Provider Details

I. General information

NPI: 1154376218
Provider Name (Legal Business Name): PEDRO L SALCEDO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 NW FEDERAL HWY
JENSEN BEACH FL
34957-3600
US

IV. Provider business mailing address

2885 SW LAKEMONT PL
PALM CITY FL
34990-6096
US

V. Phone/Fax

Practice location:
  • Phone: 800-735-1178
  • Fax: 772-223-6354
Mailing address:
  • Phone: 305-794-2939
  • Fax: 772-223-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9102068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: