Provider Demographics
NPI:1407678527
Name:SILVA, ETHIGE VAYANGANA RANMALITIE (MS)
Entity type:Individual
Prefix:
First Name:ETHIGE
Middle Name:VAYANGANA RANMALITIE
Last Name:SILVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E APACHE BLVD APT 318
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-8616
Mailing Address - Country:US
Mailing Address - Phone:480-876-1672
Mailing Address - Fax:
Practice Address - Street 1:5301 S MCCLINTOCK DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2234
Practice Address - Country:US
Practice Address - Phone:602-926-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician