Provider Demographics
NPI:1033461785
Name:DASILVA, SHANNON RILEY (CNM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RILEY
Last Name:DASILVA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WALLS DR STE 502
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4006
Mailing Address - Country:US
Mailing Address - Phone:817-556-7777
Mailing Address - Fax:
Practice Address - Street 1:4801 SLEEPY RIDGE CIR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-8328
Practice Address - Country:US
Practice Address - Phone:817-727-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741877367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife