Provider Demographics
NPI:1407305550
Name:PAULIN, GODNEY
Entity Type:Individual
Prefix:
First Name:GODNEY
Middle Name:
Last Name:PAULIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD STE 213
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1009
Mailing Address - Country:US
Mailing Address - Phone:954-659-0115
Mailing Address - Fax:
Practice Address - Street 1:601 N FLAMINGO RD STE 213
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1009
Practice Address - Country:US
Practice Address - Phone:954-659-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9109922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant