Provider Demographics
NPI:1699279463
Name:SAO TELLEZ, EMILIO JOSE (APRN)
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:JOSE
Last Name:SAO TELLEZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18638 NW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5245
Mailing Address - Country:US
Mailing Address - Phone:561-562-1739
Mailing Address - Fax:
Practice Address - Street 1:1202 NW 43RD AVE APT 1L
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2603
Practice Address - Country:US
Practice Address - Phone:561-562-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 106S00000X
FL11034539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily