Individual
SOPHIE DESSUREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4673
(813) 449-6749
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
(813) 745-4673
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME87239
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03304
BLUE CROSS BLUE SHIELD
FL
05
—
262778700
—
FL
Enumeration date
07/06/2006
Last updated
08/04/2026
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