Provider Demographics
NPI:1679089858
Name:FERRACIOLI DA SILVA, TATIANA
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:FERRACIOLI DA SILVA
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 1:24706 CHISWELL DR APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-3266
Mailing Address - Country:US
Mailing Address - Phone:808-485-9793
Mailing Address - Fax:
Practice Address - Street 1:24706 CHISWELL DR APT 2
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-3266
Practice Address - Country:US
Practice Address - Phone:808-485-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-24
Last Update Date:2017-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician