=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144842865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA FERNANDA DASILVA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2020
-----------------------------------------------------
Last Update Date | 05/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2032 EMERALD PINES DR
-----------------------------------------------------
City | TEGA CAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29708-8330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-819-7092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2032 EMERALD PINES DR
-----------------------------------------------------
City | TEGA CAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29708-8330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-819-7092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 252042
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------