Provider Demographics
NPI:1548738677
Name:SILVA, NORMAN RUDY (MS,BA)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:RUDY
Last Name:SILVA
Suffix:
Gender:M
Credentials:MS,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13990 BARTRAM PARK BLVD UNIT 1520
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5557
Mailing Address - Country:US
Mailing Address - Phone:904-294-5274
Mailing Address - Fax:
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 15
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4346
Practice Address - Country:US
Practice Address - Phone:904-745-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YM0800XMedicaid