Healthcare Provider Details

I. General information

NPI: 1285741694
Provider Name (Legal Business Name): SARA A CUELLAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 W 18TH AVE
HIALEAH FL
33012-6120
US

IV. Provider business mailing address

6415 W 18TH AVE
HIALEAH FL
33012-6120
US

V. Phone/Fax

Practice location:
  • Phone: 305-815-9636
  • Fax: 305-805-7964
Mailing address:
  • Phone: 305-815-9636
  • Fax: 305-805-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME34036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: