Provider Demographics
NPI:1942750633
Name:SILVA, SUZANA MANSOLDO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUZANA
Middle Name:MANSOLDO
Last Name:SILVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 MD-3
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-721-2333
Mailing Address - Fax:
Practice Address - Street 1:1071 MD-2
Practice Address - Street 2:SUITE 101
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-721-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0007555OtherMARYLAND BOARD OF PHYSICIANS
PAMS004000OtherSTATE LICENSE