Provider Demographics
NPI:1639328164
Name:D'SOUZA, SANITA (CCC-A/SLP)
Entity Type:Individual
Prefix:
First Name:SANITA
Middle Name:
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:CCC-A/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MAIN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1659
Mailing Address - Country:US
Mailing Address - Phone:781-337-3424
Mailing Address - Fax:
Practice Address - Street 1:825 MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1659
Practice Address - Country:US
Practice Address - Phone:781-337-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235Z00000X
MAAUD753231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist