Provider Demographics
NPI:1760297865
Name:SILVA, LUIS GUSTAVO I
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:GUSTAVO
Last Name:SILVA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SHERMAN AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5633
Mailing Address - Country:US
Mailing Address - Phone:917-484-6419
Mailing Address - Fax:
Practice Address - Street 1:101 SHERMAN AVE APT 1W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5633
Practice Address - Country:US
Practice Address - Phone:917-484-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X
NY000001171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter