Provider Demographics
NPI:1497466874
Name:PEREDA PADILLA, SULAY
Entity Type:Individual
Prefix:
First Name:SULAY
Middle Name:
Last Name:PEREDA PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NW 40TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5620
Mailing Address - Country:US
Mailing Address - Phone:786-447-2638
Mailing Address - Fax:
Practice Address - Street 1:500 NW 40TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5620
Practice Address - Country:US
Practice Address - Phone:786-447-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023193363LF0000X
FLF11220500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily