Healthcare Provider Details

I. General information

NPI: 1396563706
Provider Name (Legal Business Name): KASEY ELIZABETH DESALVO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 NORQUEST BLVD
YOUNGSTOWN OH
44515-1820
US

IV. Provider business mailing address

10802 KIRK RD
NORTH JACKSON OH
44451-9742
US

V. Phone/Fax

Practice location:
  • Phone: 330-779-0545
  • Fax:
Mailing address:
  • Phone: 330-519-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065976
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: