Provider Demographics
NPI:1346903093
Name:SAUCO ABREU, MAGALY Z (NP)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:Z
Last Name:SAUCO ABREU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 NW 77 CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-826-3072
Mailing Address - Fax:305-826-3046
Practice Address - Street 1:10550 NW 77 CT
Practice Address - Street 2:SUITE 305
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-826-3072
Practice Address - Fax:305-826-3046
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015785363LF0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116067800Medicaid