Provider Demographics
NPI:1679243455
Name:SILVA, JESSICA KAPUEONANI LONG (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KAPUEONANI LONG
Last Name:SILVA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:912 KEANUHEA ST
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7308
Mailing Address - Country:US
Mailing Address - Phone:808-344-8324
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD RM 496
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:808-344-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant