Healthcare Provider Details

I. General information

NPI: 1083535207
Provider Name (Legal Business Name): MS. GUSTAVO BERNARDINO FERREIRA DA SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GUSTAVO DA SILVA

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MADISON AVE APT 1
EVERETT MA
02149-5410
US

IV. Provider business mailing address

87 MADISON AVE APT 1
EVERETT MA
02149-5410
US

V. Phone/Fax

Practice location:
  • Phone: 857-237-4316
  • Fax:
Mailing address:
  • Phone: 857-237-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2355188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: