Provider Demographics
NPI:1386755155
Name:CUELLAR, SANDRA E (DPM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 FOREST LN
Mailing Address - Street 2:#116
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2712
Mailing Address - Country:US
Mailing Address - Phone:972-991-1700
Mailing Address - Fax:
Practice Address - Street 1:5925 FOREST LN
Practice Address - Street 2:#116
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2712
Practice Address - Country:US
Practice Address - Phone:972-991-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018650401Medicaid
TX00D52BMedicare ID - Type Unspecified
TX0821860001Medicare NSC
TX018650401Medicaid