Healthcare Provider Details

I. General information

NPI: 1255591467
Provider Name (Legal Business Name): SISSI E COSSIO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 ROYAL PALM BLVD SUITE 102
CORAL SPRINGS FL
33065-5703
US

IV. Provider business mailing address

8130 ROYAL PALM BLVD SUITE 102
CORAL SPRINGS FL
33065
US

V. Phone/Fax

Practice location:
  • Phone: 954-510-0285
  • Fax: 954-510-0286
Mailing address:
  • Phone: 954-510-0285
  • Fax: 954-510-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME94631
License Number StateFL

VIII. Authorized Official

Name: ANA LOPEZ
Title or Position: CONSULTANT
Credential:
Phone: 954-605-4391