Healthcare Provider Details

I. General information

NPI: 1043587728
Provider Name (Legal Business Name): ANGELA MARIA SALAS MS, RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 WETHEROLE ST APT 3D
REGO PARK NY
11374-4716
US

IV. Provider business mailing address

PO BOX 750537
FOREST HILLS NY
11375-0537
US

V. Phone/Fax

Practice location:
  • Phone: 718-309-8036
  • Fax:
Mailing address:
  • Phone: 718-309-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: