Provider Demographics
NPI:1194040949
Name:DE SOUZA, KELLY UGHINI (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:UGHINI
Last Name:DE SOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 NOVA DR STE B4
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5802
Mailing Address - Country:US
Mailing Address - Phone:754-200-6410
Mailing Address - Fax:754-200-6411
Practice Address - Street 1:7740 NOVA DR STE B4
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5802
Practice Address - Country:US
Practice Address - Phone:754-200-6410
Practice Address - Fax:754-200-6411
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119211207L00000X, 207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology