Provider Demographics
NPI:1376990440
Name:FELICIANO, PAULA JOHANA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JOHANA
Last Name:FELICIANO
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 1:320 HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-2909
Mailing Address - Country:US
Mailing Address - Phone:702-466-5536
Mailing Address - Fax:
Practice Address - Street 1:320 HEATHER AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-2909
Practice Address - Country:US
Practice Address - Phone:702-466-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator