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General NPI Number Information
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NPI Number | 1255342283
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Entity Type | Individual
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Provider Name | MICHEYLE GOLDMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 501 6TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | OS10421
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 237625
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License Number State | NY
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