Healthcare Provider Details

I. General information

NPI: 1023848181
Provider Name (Legal Business Name): CARLOS R CUELLAR BROWN MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 30TH AVE W APT C210
BRADENTON FL
34205-8032
US

IV. Provider business mailing address

425 30TH AVE W APT C210
BRADENTON FL
34205-8032
US

V. Phone/Fax

Practice location:
  • Phone: 917-291-4435
  • Fax: 941-328-8112
Mailing address:
  • Phone: 917-291-4435
  • Fax: 941-328-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09137
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: