Provider Demographics
NPI:1386258390
Name:SILLA, KIMBERLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:SILLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-0206
Mailing Address - Country:US
Mailing Address - Phone:716-698-7097
Mailing Address - Fax:
Practice Address - Street 1:4087 TONAWANDA CREEK RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9505
Practice Address - Country:US
Practice Address - Phone:716-698-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023641-01103T00000X
FLPY10789103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist