Healthcare Provider Details

I. General information

NPI: 1447197843
Provider Name (Legal Business Name): INDIRA REZENDE SOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 PLEASANT ST
HUDSON MA
01749-2133
US

IV. Provider business mailing address

33 PLEASANT ST
HUDSON MA
01749-2133
US

V. Phone/Fax

Practice location:
  • Phone: 929-687-7971
  • Fax:
Mailing address:
  • Phone: 929-687-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3073
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: