Provider Demographics
NPI:1205125861
Name:DA SILVA, RAPHAELLA DE SOUZA L ANTUNES (MD)
Entity type:Individual
Prefix:
First Name:RAPHAELLA
Middle Name:DE SOUZA L ANTUNES
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-283-5830
Mailing Address - Fax:
Practice Address - Street 1:465 MAIN ST
Practice Address - Street 2:APT 13C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0097
Practice Address - Country:US
Practice Address - Phone:347-252-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20190458372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology