Provider Demographics
NPI:1295354744
Name:BARROS-SIERRA, SUSANA (MD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:BARROS-SIERRA
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 1:3622 CORAL WAY APT 607
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3285
Mailing Address - Country:US
Mailing Address - Phone:631-428-7361
Mailing Address - Fax:
Practice Address - Street 1:5010 HOLLYWOOD BLVD STE 100B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6557
Practice Address - Country:US
Practice Address - Phone:954-266-2999
Practice Address - Fax:954-966-3320
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME164893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program