Provider Demographics
NPI:1043980048
Name:DIAZ, SUGEL ANDREINA
Entity type:Individual
Prefix:
First Name:SUGEL
Middle Name:ANDREINA
Last Name:DIAZ
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 1:3246 BARKER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6302
Mailing Address - Country:US
Mailing Address - Phone:786-745-2283
Mailing Address - Fax:
Practice Address - Street 1:3246 BARKER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6302
Practice Address - Country:US
Practice Address - Phone:786-745-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-519246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10201992Medicaid
NY061918OtherCOMMERCIAL INSURANCE
NY191820Medicaid