Provider Demographics
NPI:1033882568
Name:D'SOUZA, ELIZABETH XAVIER
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:XAVIER
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30B STONEGATE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-7311
Mailing Address - Country:US
Mailing Address - Phone:203-710-7665
Mailing Address - Fax:
Practice Address - Street 1:30B STONEGATE
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-7311
Practice Address - Country:US
Practice Address - Phone:203-710-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000566231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist