Provider Demographics
NPI:1770248551
Name:MUSELAIRE, GOLDA M
Entity type:Individual
Prefix:
First Name:GOLDA
Middle Name:M
Last Name:MUSELAIRE
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 1:6801 LAKE WORTH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2965
Mailing Address - Country:US
Mailing Address - Phone:561-888-9668
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE WORTH RD STE 102
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2965
Practice Address - Country:US
Practice Address - Phone:786-234-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237398251E00000X
FL237226251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health