Healthcare Provider Details

I. General information

NPI: 1184487902
Provider Name (Legal Business Name): TONYA SALERNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 RIVERSIDE AVE
MEDFORD MA
02155-5052
US

IV. Provider business mailing address

586 RIVERSIDE AVE
MEDFORD MA
02155-5052
US

V. Phone/Fax

Practice location:
  • Phone: 781-775-9680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: