{
"Npi": {
"NPI": "1205233558",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SILVANA GONZALEZ REILEY MD LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9821 NW 88TH TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DORAL",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33178-2495",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-899-0391",
"MailingAddressFaxNumber": "786-472-1280",
"FirstLinePracticeLocationAddress": "4055 NW 97TH AVE STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DORAL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33178-2911",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-452-1067",
"PracticeLocationAddressFaxNumber": "786-472-1280",
"EnumerationDate": "12/02/2014",
"LastUpdateDate": "10/27/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALEZ REILEY",
"AuthorizedOfficialFirstName": "SILVANA",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "MD MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "786-452-1067",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084N0600X",
"TaxonomyName": "Clinical Neurophysiology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "ME 105503",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}