Provider Demographics
NPI:1306845615
Name:DSILVA, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DSILVA
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: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:850-651-5600
Mailing Address - Fax:850-609-1626
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050310207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070004651OtherMEDICARE RAILROAD
FL08795Medicare PIN
E22619Medicare UPIN