Provider Demographics
NPI:1558411207
Name:BEVILACQUA, SILVIA A (MD)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:A
Last Name:BEVILACQUA
Suffix:
Gender:F
Credentials:MD
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 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-243-4603
Mailing Address - Fax:702-877-5341
Practice Address - Street 1:2845 SIENA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4153
Practice Address - Country:US
Practice Address - Phone:702-243-4603
Practice Address - Fax:702-877-5341
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88442207V00000X
MS21874207V00000X
NV17441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I169549Medicare PIN
FLH95101Medicare UPIN
FL81325Medicare ID - Type Unspecified