Provider Demographics
NPI:1285749176
Name:SILVESTRY, VYVIAN DOLORES (MD)
Entity type:Individual
Prefix:DR
First Name:VYVIAN
Middle Name:DOLORES
Last Name:SILVESTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:DOLORES
Other - Last Name:SILVESTRY-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0651
Mailing Address - Country:US
Mailing Address - Phone:787-254-1088
Mailing Address - Fax:787-254-1088
Practice Address - Street 1:44 CALLE CARBONELL STE 2
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3465
Practice Address - Country:US
Practice Address - Phone:787-254-1088
Practice Address - Fax:787-254-1088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6757208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF70588Medicare UPIN