Healthcare Provider Details

I. General information

NPI: 1003834789
Provider Name (Legal Business Name): NIHAL DE SILVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 DEL MAR HEIGHTS ROAD SUITE 947
SAN DIEGO CA
92130-2122
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD STE 947
SAN DIEGO CA
92130-2122
US

V. Phone/Fax

Practice location:
  • Phone: 973-563-6220
  • Fax:
Mailing address:
  • Phone: 973-563-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberC135933
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29446
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: