Provider Demographics
NPI:1457082695
Name:CUELLAR, STEPHANIE (OD)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 121ST TER N
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8902
Mailing Address - Country:US
Mailing Address - Phone:561-797-2231
Mailing Address - Fax:
Practice Address - Street 1:2000 PALM BEACH LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6504
Practice Address - Country:US
Practice Address - Phone:561-500-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty