Healthcare Provider Details

I. General information

NPI: 1023904281
Provider Name (Legal Business Name): SANDRA SALAMANCA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BUTTONWOODS AVE
WARWICK RI
02886-7541
US

IV. Provider business mailing address

206 BUTTONWOODS AVE
WARWICK RI
02886-7541
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-9090
  • Fax:
Mailing address:
  • Phone: 401-732-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: