Provider Demographics
NPI:1548360498
Name:DA-SILVA, SHONOLA S (MD)
Entity type:Individual
Prefix:DR
First Name:SHONOLA
Middle Name:S
Last Name:DA-SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-291-8580
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-8580
Practice Address - Fax:419-874-0196
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA649742080P0203X
OH351381602080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1131566OtherHORIZON NJ HEALTH
NJ25672OtherUNIVERISTY HEALTHPLAN
NJ8072809Medicaid
NJ01000388801OtherAMERICHOICE
NJP2753914OtherOXFORD
OH0379854Medicaid
NJ1366048OtherAMERIHEALTH PPO/ PA BS
NJ2969289OtherAETNA
NJ3K5990OtherHEALTHNET
NJ2041704OtherUNITED HEALTHCARE
NJ1366048OtherPA BS HIGHMARK
NJ2057914000OtherAMERIHEALTH/KEYSTONE/IBC
NJ8072809Medicaid