Basic Information
Provider Information | |||||||||
NPI: | 1215082102 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SILVERSTEIN | ||||||||
FirstName: | TARYN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SHAPIRO | ||||||||
OtherFirstName: | TARYN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5401 S CONGRESS AVE STE 211 | ||||||||
Address2: |   | ||||||||
City: | ATLANTIS | ||||||||
State: | FL | ||||||||
PostalCode: | 334626637 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5619648221 | ||||||||
FaxNumber: | 5619647393 | ||||||||
Practice Location | |||||||||
Address1: | 5401 S CONGRESS AVE | ||||||||
Address2: | STE 211 | ||||||||
City: | ATLANTIS | ||||||||
State: | FL | ||||||||
PostalCode: | 334626635 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5619648221 | ||||||||
FaxNumber: | 5619647393 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2007 | ||||||||
LastUpdateDate: | 01/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | OS11469 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 007340700 | 05 | FL |   | MEDICAID |