Healthcare Provider Details

I. General information

NPI: 1023133345
Provider Name (Legal Business Name): SABORAH LEE SALVATORE LICENSED PROFESSIONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 US HWY 58
DUFFIELD VA
24244
US

IV. Provider business mailing address

1100 US HWY 58 ADDINGTON HALL
DUFFIELD VA
24244-9735
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-4370
  • Fax: 276-431-2863
Mailing address:
  • Phone: 276-431-4370
  • Fax: 276-431-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701003822
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: