Healthcare Provider Details

I. General information

NPI: 1285015354
Provider Name (Legal Business Name): JACQUELYN MARIE SILVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COMMERCE ST STE 100
LINCOLN RI
02865-1186
US

IV. Provider business mailing address

1 COMMERCE ST STE 100
LINCOLN RI
02865-1186
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8484
  • Fax:
Mailing address:
  • Phone: 401-793-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD17054
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125067168
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: