MEDICARE: SALLY NELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1083563134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY NELSON

Provider Business Mailing Address
First Line	:	3549 24TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 14TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1841
Country	:	US
Telephone Number	:	617-866-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ SALLY NELSON ” Practice Location

Language	Start Address	Practice Location

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