Provider Demographics
NPI:1477818516
Name:D'SILVA, SHINY JOSE
Entity Type:Individual
Prefix:
First Name:SHINY
Middle Name:JOSE
Last Name:D'SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHINY
Other - Middle Name:JOSE
Other - Last Name:GAZENTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 PEACHTREE CT STE 105
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4616
Mailing Address - Country:US
Mailing Address - Phone:631-467-3700
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:300 BAY SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2823
Practice Address - Country:US
Practice Address - Phone:631-586-2700
Practice Address - Fax:631-586-3524
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18358225100000X
NY032534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist