Born in Schenectady, New York, Leslie Silva was raised primarily in Saratoga, New York, but also lived in Connecticut, Iowa and Georgia, moving frequently because her father worked as a nuclear engineer. She attended the University of Connecticut at Storrs, and received a BFA from the School of Drama there, and an MFA from the Juilliard School in New York.

She made her professional stage debut in a 1995 Shakespeare Theater production of "Macbeth" in Washington, DC, and starred in Sam Shepard's one-act play "Chicago", for New York's Signature Theater, in 1996. She appeared Off-Broadway in "Edmond" and starred as Helena in "A Midsummer Night's Dream" at the Guthrie Theater in Minneapolis. She has also worked in theater with Anna Deavere Smith, Wallace Shawn and Andre Gregory and made her feature-film debut with a brief role as a process server in the romantic comedy Ahmaklar acele eder (1997).

Her wide eyes, expressive features and commanding presence make for an enviable appeal, and helped her land a regular role as Dr. Helen Reynolds on the hit NBC drama Providence (1999), less than four years after her professional stage debut. As a tough and uncompromising medico, Silva offered impressive work, her skillful portrayal nuanced enough to keep the character from treading into the two-dimensional stereotype of the hard-nosed and ambitious African-American woman all too familiar on contemporary television.

Her previous television credits include guest appearances on the CBS sitcom Cosby (1996) in 1997 and as a nun on a 1998 two-part episode of NBC's police drama Homicide: Life on the Street (1993).