Healthcare Provider Details

I. General information

NPI: 1790509594
Provider Name (Legal Business Name): BARBARA MICHELE SOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 ROUTE 134
SOUTH DENNIS MA
02660-3423
US

IV. Provider business mailing address

223 MARION RD
ROCHESTER MA
02770-4120
US

V. Phone/Fax

Practice location:
  • Phone: 508-694-7901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2331987
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN2331987
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: