1811218068 NPI number — MICHELLE M SILVA-ACOSTA M.D.

Table of content: MICHELLE M SILVA-ACOSTA M.D. (NPI 1811218068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811218068 NPI number — MICHELLE M SILVA-ACOSTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVA-ACOSTA
Provider First Name:
MICHELLE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811218068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MAGNOLIA ST
Provider Second Line Business Mailing Address:
UNIT 7307
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32204-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-677-0403
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MAGNOLIA ST
Provider Second Line Business Practice Location Address:
UNIT 7307
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-677-0403
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  69714 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 4274 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 018611200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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