Healthcare Provider Details

I. General information

NPI: 1467849463
Provider Name (Legal Business Name): CHIRLYN URENA PAULINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 01/04/2022
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W STATE ROAD 434 STE 1010
LONGWOOD FL
32750-3817
US

IV. Provider business mailing address

1400 W STATE ROAD 434 STE 1010
LONGWOOD FL
32750-3817
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-9970
  • Fax: 407-644-6926
Mailing address:
  • Phone: 407-644-9970
  • Fax: 407-644-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME135503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: