Provider Demographics
NPI:1598300139
Name:ROSABAL DE SILVA, ADA (PSYD)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:ROSABAL DE SILVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8395 W OAKLAND PARK BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7346
Mailing Address - Country:US
Mailing Address - Phone:561-404-1422
Mailing Address - Fax:561-404-1425
Practice Address - Street 1:8395 W OAKLAND PARK BLVD STE C
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7346
Practice Address - Country:US
Practice Address - Phone:561-404-1422
Practice Address - Fax:561-404-1425
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical