Provider Demographics
NPI:1093735615
Name:SILVA, MILDRED DONIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:DONIS
Last Name:SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4463
Mailing Address - Country:US
Mailing Address - Phone:407-273-7399
Mailing Address - Fax:407-273-1928
Practice Address - Street 1:11616 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4463
Practice Address - Country:US
Practice Address - Phone:407-273-7399
Practice Address - Fax:407-273-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063128100Medicaid
FL14373OtherBLUECROSS BLUE SHIELD
FL063128100Medicaid
FL14373OtherBLUECROSS BLUE SHIELD