Provider Demographics
NPI:1134588346
Name:SILVA, TIMOTHY CARPENTER (NP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CARPENTER
Last Name:SILVA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DOANSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5902
Mailing Address - Country:US
Mailing Address - Phone:203-628-0434
Mailing Address - Fax:
Practice Address - Street 1:400 DOANSBURG RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5902
Practice Address - Country:US
Practice Address - Phone:203-628-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124019163W00000X
NYF402092-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$OtherSSN