Provider Demographics
NPI:1689467680
Name:DA SILVA SOUTO MAIOR, THAINA
Entity type:Individual
Prefix:
First Name:THAINA
Middle Name:
Last Name:DA SILVA SOUTO MAIOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23279 SW 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2023
Mailing Address - Country:US
Mailing Address - Phone:954-600-9846
Mailing Address - Fax:
Practice Address - Street 1:23279 SW 61ST AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2023
Practice Address - Country:US
Practice Address - Phone:954-600-9846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9120249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant