Healthcare Provider Details

I. General information

NPI: 1083390090
Provider Name (Legal Business Name): PETRA ALPHONSE SILVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

V. Phone/Fax

Practice location:
  • Phone: 646-565-8212
  • Fax:
Mailing address:
  • Phone: 646-565-8212
  • Fax: 718-963-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346845-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: