MEDICARE: MS. IMMACULATE PRASADANI DESILVA PA-C, MPH

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	363AM0700X	Medical Physician Assistant	66331	CA
2	363AM0700X	Medical Physician Assistant	028850	NY

General Provider Information

NPI Number	:	1578186458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IMMACULATE PRASADANI DESILVA PA-C, MPH

Provider Business Mailing Address
First Line	:	9900 STOCKDALE HWY
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-3632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 STOCKDALE HWY
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-3632
Country	:	US
Telephone Number	:	661-282-8998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	06/03/2026

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