Healthcare Provider Details

I. General information

NPI: 1164620696
Provider Name (Legal Business Name): NEIL ALEJANDRO SALAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 VIDINA DR
MELBOURNE FL
32940-7698
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-471-1068
  • Fax: 321-434-9285
Mailing address:
  • Phone: 321-471-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME131178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: