Basic Information
| Provider Information | |||||||||
| NPI: | 1427408525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAJEDA SILVESTRI | ||||||||
| FirstName: | EDWIN | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 JFK DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615481273 | ||||||||
| FaxNumber: | 5615481572 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 JFK DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615481903 | ||||||||
| FaxNumber: | 5614345165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | FL | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.