Provider Demographics
NPI:1710016993
Name:D'SILVA, DEIRDRE E (LIC AC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:E
Last Name:D'SILVA
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BACON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2307
Mailing Address - Country:US
Mailing Address - Phone:617-448-5898
Mailing Address - Fax:
Practice Address - Street 1:48 BACON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2307
Practice Address - Country:US
Practice Address - Phone:617-448-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226518171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist