Provider Demographics
NPI:1275701179
Name:STEPHAN A SILVA D P M PA
Entity Type:Organization
Organization Name:STEPHAN A SILVA D P M PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-241-9447
Mailing Address - Street 1:7491 N FEDERAL HWY
Mailing Address - Street 2:STE C15
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1624
Mailing Address - Country:US
Mailing Address - Phone:561-241-9447
Mailing Address - Fax:561-241-4324
Practice Address - Street 1:7491 N FEDERAL HWY
Practice Address - Street 2:STE C15
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1624
Practice Address - Country:US
Practice Address - Phone:561-241-9447
Practice Address - Fax:561-241-4324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHAN A SILVA D P M PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0787050001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65061Medicare PIN
FLU10980Medicare UPIN
FL0787050001Medicare NSC