Provider Demographics
NPI:1992725857
Name:DE SILVA, MALIKA SHANI (MD)
Entity type:Individual
Prefix:
First Name:MALIKA
Middle Name:SHANI
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-738-8855
Mailing Address - Fax:732-738-4141
Practice Address - Street 1:225 MAY ST STE B
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-738-8855
Practice Address - Fax:732-738-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07781900207QA0000X
NJ25MA07781900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7491506Medicaid
NJ11449857OtherCAQ
NJ7491506Medicaid
NJI23132Medicare UPIN