Provider Demographics
NPI:1871555128
Name:JALLOW, SULAYMAN E (MD)
Entity type:Individual
Prefix:DR
First Name:SULAYMAN
Middle Name:E
Last Name:JALLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-436-7700
Mailing Address - Fax:954-432-1769
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 413
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-436-7700
Practice Address - Fax:954-432-1769
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066202000Medicaid
FL95749BMedicare PIN
FL066202000Medicaid
FL95749Medicare PIN
FLD27901Medicare UPIN