Healthcare Provider Details

I. General information

NPI: 1265740815
Provider Name (Legal Business Name): WANDA SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6869 BELFORT OAKS PL
JACKSONVILLE FL
32216-6242
US

IV. Provider business mailing address

3160 HOLLOW TREE CT
JACKSONVILLE FL
32216-1176
US

V. Phone/Fax

Practice location:
  • Phone: 904-294-3335
  • Fax:
Mailing address:
  • Phone: 904-294-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMA-44884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: