Healthcare Provider Details

I. General information

NPI: 1578403994
Provider Name (Legal Business Name): SALMAN MIRZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MELROSE ST
MELROSE MA
02176
US

IV. Provider business mailing address

166 GRANT AVE
MEDFORD MA
02155-2765
US

V. Phone/Fax

Practice location:
  • Phone: 978-512-2699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025100903
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: