Provider Demographics
NPI:1679194310
Name:SALAMEH, BAYAN
Entity type:Individual
Prefix:
First Name:BAYAN
Middle Name:
Last Name:SALAMEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PARK PL
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-5862
Mailing Address - Country:US
Mailing Address - Phone:662-347-8206
Mailing Address - Fax:
Practice Address - Street 1:5210 WEST VILLAGE PARK WAY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-339-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94841101YP2500X, 101YP2500X
ARP2403005101YP2500X
170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics