Healthcare Provider Details

I. General information

NPI: 1699361022
Provider Name (Legal Business Name): DANIELLE ALINE SALOMONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 11/26/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CANADA ST
SWANTON VT
05488-1335
US

IV. Provider business mailing address

465 LAKEWOOD DR
SWANTON VT
05488-8094
US

V. Phone/Fax

Practice location:
  • Phone: 802-255-5518
  • Fax:
Mailing address:
  • Phone: 802-782-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number055.0031551
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number055.0031551
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number055.0031551
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number055.0031551
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: