Provider Demographics
NPI:1083672554
Name:DESOUZA, AUREA S (MD)
Entity Type:Individual
Prefix:DR
First Name:AUREA
Middle Name:S
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AUREA
Other - Middle Name:SISMEA SUSHILA
Other - Last Name:DESOUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 836
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1512
Practice Address - Country:US
Practice Address - Phone:716-855-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1621562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000525621002OtherBLUE SHIELD OF WESTERN NY
145783FFOtherPREFERRED CARE
RB6946OtherMEDICARE
000525621009OtherBLUE SHIELD OF WESTERN NY
NYCRDRA1621564OtherWORKERS COMPENSATION
00011300701OtherUNIVERA
NY01059672Medicaid
5690132OtherINDEPENDENT HEALTH
300111490OtherRAILROAD MEDICARE
P00003640OtherRAILROAD MEDICARE
00026904502OtherUNIVERA
000525621006OtherBLUE SHIELD OF WESTERN NY
P00003640OtherRAILROAD MEDICARE
5690132OtherINDEPENDENT HEALTH
DD4911Medicare PIN