Provider Demographics
NPI:1033140975
Name:AGUAYO CEDENO, SANDRA I (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:I
Last Name:AGUAYO CEDENO
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:EDIF MEDICO HNAS DAVILA
Mailing Address - Street 2:J16 CALLE 2 STE 110
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-787-3838
Mailing Address - Fax:787-785-6975
Practice Address - Street 1:EDIF MEDICO HNAS DAVILA
Practice Address - Street 2:J16 CALLE 2 STE 110
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5045
Practice Address - Country:US
Practice Address - Phone:787-787-3838
Practice Address - Fax:787-785-6975
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9894208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
88659Medicare ID - Type Unspecified
G41293Medicare UPIN