MEDICARE: SALAH NURSE PRACTITIONER IN PSYCHIATRY, PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1578432589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALAH NURSE PRACTITIONER IN PSYCHIATRY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 15
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-0015
Country	:	US
Telephone Number	:	716-427-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 BROADWAY ST
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2456
Country	:	US
Telephone Number	:	716-427-4803
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	MANAR SALAH
Credential	:	PMHNP
Telephone Number	:	716-541-7444

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	02/13/2026

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