Provider Demographics
NPI:1538588520
Name:DESALVO, LAURA MARIE (MSED)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:DESALVO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3223
Mailing Address - Country:US
Mailing Address - Phone:516-376-9702
Mailing Address - Fax:
Practice Address - Street 1:2351 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3223
Practice Address - Country:US
Practice Address - Phone:516-376-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist