Provider Demographics
NPI:1528220381
Name:AL-CHADERCHI, SILVANA YPAULS
Entity Type:Individual
Prefix:
First Name:SILVANA
Middle Name:YPAULS
Last Name:AL-CHADERCHI
Suffix:
Gender:F
Credentials:
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 20308
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0308
Mailing Address - Country:US
Mailing Address - Phone:254-537-6868
Mailing Address - Fax:254-537-6869
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-224-8188
Practice Address - Fax:254-224-8199
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1512208000000X
TXBP10031875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330097201Medicaid
TX330097201Medicaid