Provider Demographics
NPI:1932650298
Name:GOODMAN, DONYEL
Entity Type:Individual
Prefix:
First Name:DONYEL
Middle Name:
Last Name:GOODMAN
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 1:2209 CHESTNUT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3988
Mailing Address - Country:US
Mailing Address - Phone:863-606-4936
Mailing Address - Fax:
Practice Address - Street 1:2209 CHESTNUT HILLS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3988
Practice Address - Country:US
Practice Address - Phone:863-606-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker