Healthcare Provider Details

I. General information

NPI: 1558272567
Provider Name (Legal Business Name): SILVANA DE MELO GONDOLFO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6498 SW 24TH ST
MIAMI FL
33155-1949
US

IV. Provider business mailing address

3300 NE 192ND ST APT 1111
MIAMI FL
33180-2433
US

V. Phone/Fax

Practice location:
  • Phone: 786-323-6973
  • Fax: 305-907-8788
Mailing address:
  • Phone: 786-323-6973
  • Fax: 305-907-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003109PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: