Provider Demographics
NPI:1225339278
Name:D'SOUZA, SHAILA (PT)
Entity Type:Individual
Prefix:
First Name:SHAILA
Middle Name:
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5727
Mailing Address - Country:US
Mailing Address - Phone:732-741-2313
Mailing Address - Fax:732-936-8445
Practice Address - Street 1:80 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5727
Practice Address - Country:US
Practice Address - Phone:732-741-2313
Practice Address - Fax:732-936-8445
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00486000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00486000OtherLICENSE