Provider Demographics
NPI:1205233558
Name:SILVANA GONZALEZ REILEY MD LLC
Entity type:Organization
Organization Name:SILVANA GONZALEZ REILEY MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SILVANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GONZALEZ REILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-452-1067
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:786-899-0391
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0600X
FLME 1055032084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0043741-00Medicaid
FL014263900Medicaid
FLFT452WMedicare UPIN