Healthcare Provider Details

I. General information

NPI: 1396799573
Provider Name (Legal Business Name): PAULETT DIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 NW 57TH ST
SUNRISE FL
33351-4338
US

IV. Provider business mailing address

237 JOHNSON AVE
HACKENSACK NJ
07601-5138
US

V. Phone/Fax

Practice location:
  • Phone: 954-466-0003
  • Fax: 844-612-3977
Mailing address:
  • Phone: 201-343-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME156641
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07957100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: