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NPI Code Detail

MEDICARE: SARA RUSSO MD

MEDICARE: SARA RUSSO 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
1207ND0101XMOHS-Micrographic Surgery PhysicianME168072FL
2207N00000XDermatology PhysicianME168072FL

General Provider Information

NPI Number : 1659991628
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA RUSSO MD
Provider Business Mailing Address
First Line : 1460 N UNIVERSITY DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33071-6040
Country : US
Telephone Number : 954-752-7552
Fax Number : 954-752-4737
Provider Business Practice Location Address
First Line : 1460 N UNIVERSITY DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33071-6040
Country : US
Telephone Number : 954-752-7552
Fax Number : 954-752-4737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2020
Last Update Date : 12/10/2025

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Directions to “ SARA RUSSO MD” Practice Location

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