Individual
NASTASSIA DE SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
515 BELLPORT AVE, BELLPORT, NY 11713-1711
(631) 288-7120
(929) 455-9423
Mailing address
515 BELLPORT AVE, BELLPORT, NY 11713-1711
(631) 288-7120
(929) 455-9423
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT209620
PA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
323186
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103292986
—
PA
Enumeration date
07/08/2015
Last updated
09/18/2023
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