MEDICARE: DR. BRIANNA DE SOUZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2018-02230	NC
2	207N00000X	Dermatology Physician	ME146005	FL

General Provider Information

NPI Number	:	1396273215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIANNA DE SOUZA MD

Provider Business Mailing Address
First Line	:	PO BOX 23329
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3329
Country	:	US
Telephone Number	:
Fax Number	:	410-883-0876

Provider Business Practice Location Address
First Line	:	6331 MEMORIAL HWY SUITE A AND D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615
Country	:	US
Telephone Number	:	813-682-1031
Fax Number	:	813-682-1032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	02/03/2026

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