Provider Demographics
NPI:1649859026
Name:SILVESTRINI MAVROVICH, MELANIE ROSALIA
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSALIA
Last Name:SILVESTRINI MAVROVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 33RD RD APT 4C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4250
Mailing Address - Country:US
Mailing Address - Phone:407-861-7265
Mailing Address - Fax:
Practice Address - Street 1:6600 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6450
Practice Address - Country:US
Practice Address - Phone:786-713-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL275351223G0001X
NY0627601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice