Provider Demographics
NPI:1386350668
Name:DA SILVA, MARCO ANTONIO HELIO (AP)
Entity type:Individual
Prefix:
First Name:MARCO ANTONIO
Middle Name:HELIO
Last Name:DA SILVA
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CARRERA ST APT 64
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3544
Mailing Address - Country:US
Mailing Address - Phone:904-496-5220
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2693
Practice Address - Country:US
Practice Address - Phone:904-300-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4422208VP0000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine