Provider Demographics
NPI:1619324563
Name:DASILVA, JULIANA N
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:N
Last Name:DASILVA
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 1:59 WILSON AVE
Mailing Address - Street 2:#3
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3216
Mailing Address - Country:US
Mailing Address - Phone:186-290-2979
Mailing Address - Fax:186-290-2979
Practice Address - Street 1:59 WILSON AVE
Practice Address - Street 2:#3
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3216
Practice Address - Country:US
Practice Address - Phone:186-290-2979
Practice Address - Fax:186-290-2979
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator