Healthcare Provider Details

I. General information

NPI: 1376971556
Provider Name (Legal Business Name): SERGIO MORELLO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 08/06/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OAKLAND DRIVE UNIT 205
SUNRISE FL
33351-6741
US

IV. Provider business mailing address

7800 W OAKLAND DRIVE UNIT 205
SUNRISE FL
33351-6741
US

V. Phone/Fax

Practice location:
  • Phone: 954-859-2020
  • Fax: 954-736-4344
Mailing address:
  • Phone: 954-859-2020
  • Fax: 954-736-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number73461
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME121631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: