Healthcare Provider Details

I. General information

NPI: 1952984486
Provider Name (Legal Business Name): AMITA JANE DSOUZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE
MEMPHIS TN
38103-3438
US

IV. Provider business mailing address

550 TECHNO LN APT 816
MEMPHIS TN
38105-5226
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5500
  • Fax:
Mailing address:
  • Phone: 832-803-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW3250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: