Provider Demographics
NPI:1043843691
Name:GODWIN, ASHLEY MONIQUE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MONIQUE
Last Name:GODWIN
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 1:98 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6837
Mailing Address - Country:US
Mailing Address - Phone:516-655-6957
Mailing Address - Fax:
Practice Address - Street 1:98 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-6837
Practice Address - Country:US
Practice Address - Phone:516-655-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program