Provider Demographics
NPI:1346827128
Name:SILADI, JILL M (MSN, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:SILADI
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SHAFER CT STE 700
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4989
Mailing Address - Country:US
Mailing Address - Phone:346-376-1702
Mailing Address - Fax:
Practice Address - Street 1:1579 STRAITS TPKE STE 1E
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-490-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT135673390200000X
CT10135673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program