Provider Demographics
NPI:1780123851
Name:HERNANDEZ ACEVEDO, SUGEILY
Entity type:Individual
Prefix:
First Name:SUGEILY
Middle Name:
Last Name:HERNANDEZ ACEVEDO
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 1:33 SE 8TH ST APT 427
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6425
Mailing Address - Country:US
Mailing Address - Phone:787-932-4029
Mailing Address - Fax:
Practice Address - Street 1:3207 N STATE ROAD 7 STE 24
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7008
Practice Address - Country:US
Practice Address - Phone:954-979-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice