Provider Demographics
NPI:1346777067
Name:KELLEY DASILVA, BRIDGETTE J (BS)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:J
Last Name:KELLEY DASILVA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:J
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20345 W COUNTRY CLUB DR
Mailing Address - Street 2:PH 14
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1631
Mailing Address - Country:US
Mailing Address - Phone:305-792-4931
Mailing Address - Fax:305-466-2437
Practice Address - Street 1:20345 W COUNTRY CLUB DR
Practice Address - Street 2:PH 14
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1631
Practice Address - Country:US
Practice Address - Phone:305-792-4931
Practice Address - Fax:305-466-2437
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLK432070847710171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator