Provider Demographics
NPI:1285741694
Name:CUELLAR, SARA A (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6120
Mailing Address - Country:US
Mailing Address - Phone:305-815-9636
Mailing Address - Fax:305-805-7964
Practice Address - Street 1:6415 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6120
Practice Address - Country:US
Practice Address - Phone:305-815-9636
Practice Address - Fax:305-805-7964
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC46078138956DOtherDRIVER LICENSE
FLC46078138956DOtherDRIVER LICENSE
FLBC8230168OtherDEA FEDERAL
FLC46078138956DOtherDRIVER LICENSE