Provider Demographics
NPI:1922389808
Name:DASILVA, KELLEY C (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:C
Last Name:DASILVA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 POST RD 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5916
Mailing Address - Country:US
Mailing Address - Phone:203-441-5680
Mailing Address - Fax:475-330-9015
Practice Address - Street 1:1506 POST RD 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5916
Practice Address - Country:US
Practice Address - Phone:203-441-5680
Practice Address - Fax:475-330-9015
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist