Provider Demographics
NPI:1730578170
Name:NOGUEIRAS, GLADYS MAYTE (MD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:MAYTE
Last Name:NOGUEIRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:MAYTE
Other - Last Name:NOGUEIRAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4269 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6044
Mailing Address - Country:US
Mailing Address - Phone:954-578-0200
Mailing Address - Fax:954-578-0050
Practice Address - Street 1:3990 SHERIDAN ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3655
Practice Address - Country:US
Practice Address - Phone:954-987-4455
Practice Address - Fax:954-964-7342
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13267-I208D00000X
FLACN 822208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice