Provider Demographics
NPI:1760137830
Name:DASILVA, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DASILVA
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 1:322 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1305
Mailing Address - Country:US
Mailing Address - Phone:516-850-1392
Mailing Address - Fax:
Practice Address - Street 1:5 DAKOTA DR STE 200
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1109
Practice Address - Country:US
Practice Address - Phone:646-789-1157
Practice Address - Fax:631-752-0536
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator