Provider Demographics
NPI:1891940474
Name:GALDONA-GORASSINI, TERESA J (PAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:GALDONA-GORASSINI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1101
Mailing Address - Country:US
Mailing Address - Phone:305-255-1355
Mailing Address - Fax:305-255-2015
Practice Address - Street 1:11211 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1101
Practice Address - Country:US
Practice Address - Phone:305-255-1355
Practice Address - Fax:305-255-2015
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant