Provider Demographics
NPI:1710610993
Name:PAULINO, JUCELY (DMS)
Entity Type:Individual
Prefix:
First Name:JUCELY
Middle Name:
Last Name:PAULINO
Suffix:
Gender:F
Credentials:DMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4668
Mailing Address - Country:US
Mailing Address - Phone:407-747-1763
Mailing Address - Fax:
Practice Address - Street 1:3487 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4668
Practice Address - Country:US
Practice Address - Phone:407-747-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL220000444922085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound