Provider Demographics
NPI:1629491634
Name:DA SILVA, GILSON BORGES (MACO, MDIV)
Entity Type:Individual
Prefix:MR
First Name:GILSON
Middle Name:BORGES
Last Name:DA SILVA
Suffix:
Gender:M
Credentials:MACO, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13975 PEACH ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5657
Mailing Address - Country:US
Mailing Address - Phone:617-821-6242
Mailing Address - Fax:
Practice Address - Street 1:3125 BRUTON BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6608
Practice Address - Country:US
Practice Address - Phone:407-514-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health