Healthcare Provider Details

I. General information

NPI: 1114908845
Provider Name (Legal Business Name): SUELANE SOUSA DO OURO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 57TH ST SUITE 608
NEW YORK NY
10019-3211
US

IV. Provider business mailing address

800 2ND AVE RM 900
NEW YORK NY
10017-9218
US

V. Phone/Fax

Practice location:
  • Phone: 212-581-4488
  • Fax: 212-581-4141
Mailing address:
  • Phone: 212-581-4488
  • Fax: 212-581-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number226227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: