Provider Demographics
NPI:1629712997
Name:SILVA, SHANTEL ELLYCE (MEDICAL TATTOOIST)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:ELLYCE
Last Name:SILVA
Suffix:
Gender:F
Credentials:MEDICAL TATTOOIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 GREELEY MALL # 27
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8522
Mailing Address - Country:US
Mailing Address - Phone:970-573-5248
Mailing Address - Fax:
Practice Address - Street 1:2050 GREELEY MALL # 27
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8522
Practice Address - Country:US
Practice Address - Phone:970-573-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter