Healthcare Provider Details

I. General information

NPI: 1629693965
Provider Name (Legal Business Name): DANIELLE SILVA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE 4654
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

725 PRIMERA BLVD STE 140
LAKE MARY FL
32746-2130
US

V. Phone/Fax

Practice location:
  • Phone: 217-337-9757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002835
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11007670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: