Provider Demographics
NPI:1275526162
Name:DSILVA, STANY A (MD)
Entity Type:Individual
Prefix:
First Name:STANY
Middle Name:A
Last Name:DSILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1553
Mailing Address - Country:US
Mailing Address - Phone:913-383-9099
Mailing Address - Fax:913-383-3103
Practice Address - Street 1:8800 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1553
Practice Address - Country:US
Practice Address - Phone:913-383-9099
Practice Address - Fax:913-383-3103
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-12-02
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
KS04-26638207R00000X
MO2003013338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00005112OtherRAILROAD MEDICARE
1436130OtherUNITED HEALTHCARE
MO23788024OtherBLUE CROSS BLUE SHIELD
MOP00048117OtherRAILROAD MEDICARE
MOP00048117OtherRAILROAD MEDICARE
1436130OtherUNITED HEALTHCARE
KSP00005112OtherRAILROAD MEDICARE