Individual
AUDREY H DESILVA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10 GRAHAM RD W, ITHACA, NY 14850-1055
(607) 257-2188
(607) 266-7341
Mailing address
10 GRAHAM RD W, ITHACA, NY 14850-1055
(607) 257-2188
(607) 266-7341
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
211165
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000910782001
HEALTHNOW
—
05
—
01868340
—
NY
01
—
5677620
AETNA MANAGED CHOICE
—
01
—
6477
TOTAL CARE/MANAGED MA
NY
01
—
V018315
TRICARE
—
Enumeration date
11/16/2005
Last updated
07/08/2007
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