Healthcare Provider Details

I. General information

NPI: 1104781392
Provider Name (Legal Business Name): SILVIANA VINA CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W MARTIN LUTHER KING BLVD UNIT 1811
CHARLOTTE NC
28202-2030
US

IV. Provider business mailing address

255 W MARTIN LUTHER KING BLVD UNIT 1811
CHARLOTTE NC
28202-2030
US

V. Phone/Fax

Practice location:
  • Phone: 980-420-3797
  • Fax:
Mailing address:
  • Phone: 980-420-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: