Provider Demographics
NPI:1760061311
Name:CINTRON, SULLY (PA)
Entity Type:Individual
Prefix:
First Name:SULLY
Middle Name:
Last Name:CINTRON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SULLY
Other - Middle Name:
Other - Last Name:CINTRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 04 BOX 12128
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-9695
Mailing Address - Country:US
Mailing Address - Phone:787-930-7086
Mailing Address - Fax:
Practice Address - Street 1:DEPARTAMENTO DE SALUD DE PUERTO RICO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-765-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR778030OtherIRS ID