Provider Demographics
NPI:1811218068
Name:SILVA-ACOSTA, MICHELLE M (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:SILVA-ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 MAGNOLIA ST
Mailing Address - Street 2:UNIT 7307
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2200
Mailing Address - Country:US
Mailing Address - Phone:787-677-0403
Mailing Address - Fax:
Practice Address - Street 1:100 MAGNOLIA ST
Practice Address - Street 2:UNIT 7307
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2200
Practice Address - Country:US
Practice Address - Phone:787-677-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69714174400000X
GA4274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist