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General NPI Number Information
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NPI Number | 1205125861
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Entity Type | Individual
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Provider Name | RAPHAELLA DE SOUZA L ANTUNES DA SILVA MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 465 MAIN ST APT 13C
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City | NEW YORK
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State | NY
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Zip | 10044-0097
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Country | US
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Telephone | 347-252-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 11995 SINGLETREE LN STE 500
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5349
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Country | US
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Telephone | 952-283-5830
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2019045837
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License Number State | MO
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