Provider Demographics
NPI:1437258035
Name:BAEZ, SAYONARA J (MD)
Entity Type:Individual
Prefix:
First Name:SAYONARA
Middle Name:J
Last Name:BAEZ
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:PO BOX 551746
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1746
Mailing Address - Country:US
Mailing Address - Phone:954-381-4737
Mailing Address - Fax:
Practice Address - Street 1:1411 SAWGRASS CORPORATE PKWY STE 10-B
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2888
Practice Address - Country:US
Practice Address - Phone:954-381-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME750242084P0800X
FL750242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257362800Medicaid
FL257362801Medicaid
H06886Medicare UPIN
FL257362800Medicaid