Healthcare Provider Details

I. General information

NPI: 1992292668
Provider Name (Legal Business Name): SARAH SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLEMAN DR
SAINT AUGUSTINE FL
32084
US

IV. Provider business mailing address

437 ROYAL TERN DR
BAREFOOT BAY FL
32976-7434
US

V. Phone/Fax

Practice location:
  • Phone: 727-967-1036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA16116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: