Provider Demographics
NPI:1871943431
Name:SILVA, URSULA (LICAC)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5408
Mailing Address - Country:US
Mailing Address - Phone:845-561-3214
Mailing Address - Fax:845-565-0319
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:SUITE # 2
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5408
Practice Address - Country:US
Practice Address - Phone:845-561-3214
Practice Address - Fax:845-565-0319
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002814171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist