Provider Demographics
NPI:1144862541
Name:PEREZ DE LA IGLESIA, SULAY (APRNCB)
Entity type:Individual
Prefix:
First Name:SULAY
Middle Name:
Last Name:PEREZ DE LA IGLESIA
Suffix:
Gender:F
Credentials:APRNCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NW 15TH ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2990
Mailing Address - Country:US
Mailing Address - Phone:786-894-6358
Mailing Address - Fax:
Practice Address - Street 1:8415 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2305
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty