Desilva, Audrey H

Desilva, Audrey H is an individual health care provider with primary practice located at 10 Graham Rd W , Ithaca NY 14850-1055. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Desilva, Audrey H can be contacted via phone (607) 257-2188.

Contact Information

Primary practice address
10 Graham Rd W Ithaca NY 14850-1055
Phone: (607) 257-2188
Fax: (607) 266-7341
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 211165 New York

Profile Details

NPI number 1356323133
LBN Legal business name Desilva, Audrey H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 16th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356323133 NPPES
Other V018315 TRICARE
Other 000910782001 TRICARE
Other 5677620 TRICARE
Other 6477 TRICARE
MEDICAID 01868340 TRICARE

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