Provider Demographics
NPI:1336143999
Name:AGUIAR, SUSAN WELLS (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WELLS
Last Name:AGUIAR
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 1:1162 CYPRESS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7560
Mailing Address - Country:US
Mailing Address - Phone:407-343-9006
Mailing Address - Fax:407-343-9006
Practice Address - Street 1:1162 CYPRESS GLEN CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7560
Practice Address - Country:US
Practice Address - Phone:407-343-9006
Practice Address - Fax:407-343-9006
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66810207Y00000X
ALMD.34973207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376299800Medicaid
FL007914900Medicare PIN
26157YMedicare PIN
F90351Medicare UPIN