Provider Demographics
NPI:1952682783
Name:GONZALEZ REILEY, SILVANA G (MD)
Entity Type:Individual
Prefix:DR
First Name:SILVANA
Middle Name:G
Last Name:GONZALEZ REILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 NW 88TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2495
Mailing Address - Country:US
Mailing Address - Phone:786-452-1067
Mailing Address - Fax:786-472-1280
Practice Address - Street 1:4055 NW 97TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2911
Practice Address - Country:US
Practice Address - Phone:786-452-1067
Practice Address - Fax:786-472-1280
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105503207R00000X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIF567AMedicare PIN