Healthcare Provider Details

I. General information

NPI: 1245160142
Provider Name (Legal Business Name): EMYLIE SALCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E 190TH ST APT 1D
BRONX NY
10468-4550
US

IV. Provider business mailing address

521 BROADWAY FL 4
NEW YORK NY
10012-4454
US

V. Phone/Fax

Practice location:
  • Phone: 917-703-7072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number127161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: