Provider Demographics
NPI:1073788550
Name:NANCY DSILVA PA
Entity Type:Organization
Organization Name:NANCY DSILVA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DSILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-651-5600
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 10TH AVE
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1304
Practice Address - Country:US
Practice Address - Phone:850-651-5600
Practice Address - Fax:850-609-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050310207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070004651OtherMEDICARE RAILROAD
FL08795Medicare PIN
FL070004651OtherMEDICARE RAILROAD