Provider Demographics
NPI:1265912505
Name:MURILLO, SULAYMI
Entity type:Individual
Prefix:MRS
First Name:SULAYMI
Middle Name:
Last Name:MURILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SULAYMI
Other - Middle Name:
Other - Last Name:JORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2320 SW 18TH PLACE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3507
Mailing Address - Country:US
Mailing Address - Phone:239-334-6160
Mailing Address - Fax:
Practice Address - Street 1:1650 MEDICAL LANE STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1116
Practice Address - Country:US
Practice Address - Phone:239-334-6160
Practice Address - Fax:239-334-1339
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9569899163W00000X
222Q00000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117912800Medicaid
FLM640780799160OtherDRIVER LICENSE