Provider Demographics
NPI:1497418685
Name:SILVA, MYRDEOMAR
Entity Type:Individual
Prefix:MS
First Name:MYRDEOMAR
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYE
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1905 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-1926
Mailing Address - Country:US
Mailing Address - Phone:440-222-6135
Mailing Address - Fax:
Practice Address - Street 1:1905 E 32ND ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1926
Practice Address - Country:US
Practice Address - Phone:440-222-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171R00000XOther Service ProvidersInterpreter