Provider Demographics
NPI:1982292306
Name:DASILVA, ADICEL MARIO
Entity Type:Individual
Prefix:
First Name:ADICEL
Middle Name:MARIO
Last Name:DASILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WINTHROP SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1237
Mailing Address - Country:US
Mailing Address - Phone:617-710-2284
Mailing Address - Fax:
Practice Address - Street 1:120 WINTHROP SHORE DR
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1237
Practice Address - Country:US
Practice Address - Phone:617-710-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty