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General NPI Number Information
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NPI Number | 1902487721
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Entity Type | Individual
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Provider Name | MISHELL ANDREA SILES BORDA MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 100 15TH ST NW
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City | NORTON
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State | VA
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Zip | 24273-1616
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Country | US
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Telephone | 276-679-2141
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Fax | 276-439-1872
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Provider Business Mailing Address
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Address Line | 100 15TH ST NW
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City | NORTON
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State | VA
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Zip | 24273-1616
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Country | US
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Telephone | 276-679-2141
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Fax | 276-439-1872
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116037549
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License Number State | VA
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