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General NPI Number Information
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NPI Number | 1811218068
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Entity Type | Individual
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Provider Name | MICHELLE M SILVA-ACOSTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 100 MAGNOLIA ST UNIT 7307
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City | JACKSONVILLE
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State | FL
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Zip | 32204-2200
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Country | US
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Telephone | 787-677-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MAGNOLIA ST UNIT 7307
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City | JACKSONVILLE
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State | FL
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Zip | 32204-2200
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Country | US
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Telephone | 787-677-0403
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 69714
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4274
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License Number State | GA
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