Provider Demographics
NPI:1992905970
Name:GULLO, PAUL R (AUD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:GULLO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:RUSSELL
Other - Last Name:GULLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7405
Mailing Address - Country:US
Mailing Address - Phone:904-858-1912
Mailing Address - Fax:
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7405
Practice Address - Country:US
Practice Address - Phone:904-858-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1776231HA2400X, 237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400006715Medicare PIN