Provider Demographics
NPI:1114908845
Name:DO OURO, SUELANE SOUSA (MD)
Entity Type:Individual
Prefix:
First Name:SUELANE
Middle Name:SOUSA
Last Name:DO OURO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 2ND AVE
Mailing Address - Street 2:RM 900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9218
Mailing Address - Country:US
Mailing Address - Phone:212-581-4488
Mailing Address - Fax:212-581-4141
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-581-4488
Practice Address - Fax:212-581-4141
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226227208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79822Medicare UPIN
H79822Medicare UPIN
NY32P641Medicare ID - Type Unspecified