Provider Demographics
NPI:1851883581
Name:ROMAN LOPEZ, SUELY J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SUELY
Middle Name:J
Last Name:ROMAN LOPEZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:SUELY
Other - Middle Name:
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1600 S ANDREWS AVE FL 33316
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2510
Mailing Address - Country:US
Mailing Address - Phone:954-355-4400
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE FL 33316
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10063755207R00000X
FL33494390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine