Healthcare Provider Details

I. General information

NPI: 1659991628
Provider Name (Legal Business Name): SARA RUSSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA YUMEEN

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6040
US

IV. Provider business mailing address

1460 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6040
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-7552
  • Fax: 954-752-4737
Mailing address:
  • Phone: 954-752-7552
  • Fax: 954-752-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME168072
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME168072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: