Healthcare Provider Details

I. General information

NPI: 1295354744
Provider Name (Legal Business Name): SUSANA BARROS-SIERRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 HOLLYWOOD BLVD STE 100B
HOLLYWOOD FL
33021-6557
US

IV. Provider business mailing address

3622 CORAL WAY APT 607
MIAMI FL
33145-3285
US

V. Phone/Fax

Practice location:
  • Phone: 954-266-2999
  • Fax: 954-966-3320
Mailing address:
  • Phone: 631-428-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME164893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: