Provider Demographics
NPI:1407471105
Name:GODYN, DYLAN GENE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:GENE
Last Name:GODYN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUMMER CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1868
Mailing Address - Country:US
Mailing Address - Phone:401-952-9477
Mailing Address - Fax:
Practice Address - Street 1:9 SUMMER CT
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1868
Practice Address - Country:US
Practice Address - Phone:401-952-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant