Healthcare Provider Details

I. General information

NPI: 1306845615
Provider Name (Legal Business Name): NANCY DSILVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 10TH AVE
SHALIMAR FL
32579-1304
US

IV. Provider business mailing address

PO BOX 815
SHALIMAR FL
32579-0815
US

V. Phone/Fax

Practice location:
  • Phone: 850-651-5600
  • Fax: 850-609-1626
Mailing address:
  • Phone: 850-651-5600
  • Fax: 850-609-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0050310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: