1083672554 NPI number — DR. AUREA S DESOUZA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083672554 NPI number — DR. AUREA S DESOUZA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DESOUZA

Provider First Name:

AUREA

Provider Middle Name:

S

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

DESOUZA

Provider Other First Name:

AUREA

Provider Other Middle Name:

SISMEA SUSHILA

Provider Other Name Prefix Text:

DR.

Provider Other Name Suffix Text:

Provider Other Credential Text:

M.D.

Provider Other Last Name Type Code:

5

NPI Number:

1083672554

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/10/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 8000

Provider Second Line Business Mailing Address:

DEPT 836

Provider Business Mailing Address City Name:

BUFFALO

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

14267

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

222 GENESEE ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BUFFALO

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

14203-1512

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

716-855-2866

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  162156 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000525621002 . This is a "BLUE SHIELD OF WESTERN NY" identifier . This identifiers is of the category "OTHER".
• Identifier: 145783FF . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: RB6946 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 000525621009 . This is a "BLUE SHIELD OF WESTERN NY" identifier . This identifiers is of the category "OTHER".
• Identifier: CRDRA1621564 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00011300701 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
• Identifier: 01059672 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 5690132 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 300111490 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: P00003640 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 00026904502 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
• Identifier: 000525621006 . This is a "BLUE SHIELD OF WESTERN NY" identifier . This identifiers is of the category "OTHER".