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General NPI Number Information
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NPI Number | 1144221862
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Entity Type | Individual
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Provider Name | GRACIETTE DA SILVA PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 1 RANDALL SQ STE 306
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City | PROVIDENCE
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State | RI
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Zip | 02904-2751
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Country | US
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Telephone | 401-751-7546
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Fax | 401-751-6888
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Provider Business Mailing Address
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Address Line | 1 RANDALL SQ STE 306
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City | PROVIDENCE
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State | RI
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Zip | 02904-2751
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Country | US
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Telephone | 401-751-7546
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Fax | 401-751-6888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA7524
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA00145
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA7524
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00145
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License Number State | RI
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