Provider Demographics
NPI:1134507874
Name:PAULIUS, JUDITHE (DO)
Entity type:Individual
Prefix:MS
First Name:JUDITHE
Middle Name:
Last Name:PAULIUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5907
Mailing Address - Country:US
Mailing Address - Phone:407-628-4312
Mailing Address - Fax:407-628-1845
Practice Address - Street 1:402 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5907
Practice Address - Country:US
Practice Address - Phone:407-628-4312
Practice Address - Fax:407-628-1845
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019378207Q00000X
390200000X
FLOS20659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103524374Medicaid