Provider Demographics
NPI:1043531882
Name:SALAS, ALICIA ANN (DO)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:ANN
Last Name:SALAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SUMMER ST.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-324-4109
Mailing Address - Fax:203-969-1271
Practice Address - Street 1:1275 SUMMER ST.
Practice Address - Street 2:SUITE 301
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-324-4109
Practice Address - Fax:203-969-1271
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09315100208000000X
390200000X
CT056487208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program