Provider Demographics
NPI:1477590875
Name:DE SOUZA, SYLVIE D (MD)
Entity type:Individual
Prefix:
First Name:SYLVIE
Middle Name:D
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 1:1623 3RD AVE APT 29A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3643
Mailing Address - Country:US
Mailing Address - Phone:212-831-6901
Mailing Address - Fax:
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:BROOKLYN HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-6889
Practice Address - Fax:718-250-6528
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0587000207P00000X
NY189977207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC63063Medicare UPIN
NJ083028DHKMedicare ID - Type Unspecified