Provider Demographics
NPI:1811921398
Name:MULERO, SUSAN FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FAYE
Last Name:MULERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GRAND REGENCY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-3935
Mailing Address - Country:US
Mailing Address - Phone:813-827-9798
Mailing Address - Fax:
Practice Address - Street 1:220 GRAND REGENCY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3935
Practice Address - Country:US
Practice Address - Phone:813-827-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 7229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine