Healthcare Provider Details

I. General information

NPI: 1629742036
Provider Name (Legal Business Name): AMANDA MARIE FERNANDES SILVERIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 PASHAK COURT
MISSISSAUGA ONTARIO (ON)
L5A1H7
CA

IV. Provider business mailing address

2140 PASHAK COURT
MISSISSAUGA ONTARIO (ON)
L5A1H7
CA

V. Phone/Fax

Practice location:
  • Phone: 647-207-6510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351048500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: