Provider Demographics
NPI:1356728067
Name:PEREZ CEBALLOS, SANLLY (MD)
Entity type:Individual
Prefix:DR
First Name:SANLLY
Middle Name:
Last Name:PEREZ CEBALLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SANLLY
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:813-871-2717
Mailing Address - Fax:813-876-3558
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 850
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6397
Practice Address - Country:US
Practice Address - Phone:813-871-2717
Practice Address - Fax:813-876-3558
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine