Provider Demographics
NPI:1457380958
Name:DESILVA, PRIYANI M (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANI
Middle Name:M
Last Name:DESILVA
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 1:80 OCEAN TER
Mailing Address - Street 2:STATEN ISLAND
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5650
Mailing Address - Country:US
Mailing Address - Phone:718-698-0294
Mailing Address - Fax:
Practice Address - Street 1:80 VANDAM ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1007
Practice Address - Country:US
Practice Address - Phone:212-366-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1461452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW2372-1Medicare ID - Type Unspecified