MEDICARE: DR. SUSAN WELLS AGUIAR M.D.

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	207Y00000X	Otolaryngology Physician	ME66810	FL
2	207Y00000X	Otolaryngology Physician	MD.34973	AL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336143999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN WELLS AGUIAR M.D.

Provider Business Mailing Address
First Line	:	1162 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7560
Country	:	US
Telephone Number	:	407-343-9006
Fax Number	:	407-343-9006

Provider Business Practice Location Address
First Line	:	1162 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7560
Country	:	US
Telephone Number	:	407-343-9006
Fax Number	:	407-343-9006

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/25/2022

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