Provider Demographics
NPI:1962654616
Name:DA SILVA, CHAUNTEL E (OD)
Entity Type:Individual
Prefix:
First Name:CHAUNTEL
Middle Name:E
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHAUNTEL
Other - Middle Name:E
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8810 NW 155TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1411
Mailing Address - Country:US
Mailing Address - Phone:305-815-9755
Mailing Address - Fax:305-470-2999
Practice Address - Street 1:13450 SW 120TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7393
Practice Address - Country:US
Practice Address - Phone:305-964-4240
Practice Address - Fax:305-964-4241
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006682000Medicaid