Healthcare Provider Details

I. General information

NPI: 1710809116
Provider Name (Legal Business Name): NICOLAS SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CONNECTICUT AVE
NORWALK CT
06854-1525
US

IV. Provider business mailing address

182 LAWN AVE
STAMFORD CT
06902-3152
US

V. Phone/Fax

Practice location:
  • Phone: 203-851-1000
  • Fax:
Mailing address:
  • Phone: 203-424-7621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: