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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356323133 | NPPES |
| Other | V018315 | TRICARE | |
| Other | 000910782001 | TRICARE | |
| Other | 5677620 | TRICARE | |
| Other | 6477 | TRICARE | |
| MEDICAID | 01868340 | TRICARE |
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