Provider Demographics
NPI:1083592398
Name:SALAS, ADALAIDE (CLC)
Entity type:Individual
Prefix:
First Name:ADALAIDE
Middle Name:
Last Name:SALAS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:ADALAIDE
Other - Middle Name:
Other - Last Name:MAINVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 DONAU AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8202
Mailing Address - Country:US
Mailing Address - Phone:765-461-8956
Mailing Address - Fax:
Practice Address - Street 1:2040 PALM BAY RD NE
Practice Address - Street 2:UNIT 6 #119
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905
Practice Address - Country:US
Practice Address - Phone:321-237-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN