MEDICARE: ELAINE DESILVA, PHD., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS006192L	PA

General Provider Information

NPI Number	:	1164448866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAINE DESILVA, PHD., P.C.

Provider Business Mailing Address
First Line	:	1845 WALNUT ST
Second Line	:	SUITE 2323
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4708
Country	:	US
Telephone Number	:	215-546-1404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 WALNUT ST
Second Line	:	SUITE 2323
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4708
Country	:	US
Telephone Number	:	215-546-1404
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELAINE M DESILVA
Credential	:	PH.D.
Telephone Number	:	215-546-1494

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/09/2008

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