Provider Demographics
NPI:1740742766
Name:PUELLO, PERSIS CELINA (MD)
Entity type:Individual
Prefix:
First Name:PERSIS
Middle Name:CELINA
Last Name:PUELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PERSIS
Other - Middle Name:CELINA
Other - Last Name:PUELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14100 58TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-9900
Mailing Address - Country:US
Mailing Address - Phone:727-824-8181
Mailing Address - Fax:
Practice Address - Street 1:247 S HUEY AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4205
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155116207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine