Healthcare Provider Details

I. General information

NPI: 1184209165
Provider Name (Legal Business Name): MELISSA L. SILVA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINCOLN ST
WORCESTER MA
01605-2060
US

IV. Provider business mailing address

55 GOODALE ST
WEST BOYLSTON MA
01583-1005
US

V. Phone/Fax

Practice location:
  • Phone: 508-854-2122
  • Fax: 508-853-2288
Mailing address:
  • Phone: 508-523-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN198426
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: