Provider Demographics
NPI:1316395999
Name:MESTIZO, SILVIANA
Entity type:Individual
Prefix:
First Name:SILVIANA
Middle Name:
Last Name:MESTIZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2208
Mailing Address - Country:US
Mailing Address - Phone:516-652-1690
Mailing Address - Fax:
Practice Address - Street 1:3 DECATUR ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-2208
Practice Address - Country:US
Practice Address - Phone:516-652-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist