MEDICARE: SUSANA BARROS-SIERRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	ME164893	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295354744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA BARROS-SIERRA MD

Provider Business Mailing Address
First Line	:	3622 CORAL WAY APT 607
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3285
Country	:	US
Telephone Number	:	631-428-7361
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 HOLLYWOOD BLVD STE 100B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6557
Country	:	US
Telephone Number	:	954-266-2999
Fax Number	:	954-966-3320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	10/09/2023

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Directions to “ SUSANA BARROS-SIERRA MD” Practice Location

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