Healthcare Provider Details

I. General information

NPI: 1134842230
Provider Name (Legal Business Name): JESSICA SALVADON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LINDEN AVE
SPRING VALLEY NY
10977-3945
US

IV. Provider business mailing address

19 LINDEN AVE
SPRING VALLEY NY
10977-3945
US

V. Phone/Fax

Practice location:
  • Phone: 845-671-9772
  • Fax:
Mailing address:
  • Phone: 845-671-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number354851
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: