Provider Demographics
NPI:1225389620
Name:DUCELLARI, BRUNILDA (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUNILDA
Middle Name:
Last Name:DUCELLARI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SW 107TH AVE STE 301E
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2553
Mailing Address - Country:US
Mailing Address - Phone:130-548-0204
Mailing Address - Fax:305-480-2046
Practice Address - Street 1:1401 SW 107TH AVE STE 301E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2553
Practice Address - Country:US
Practice Address - Phone:305-480-2045
Practice Address - Fax:305-480-2046
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3575213ES0000X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery