Healthcare Provider Details

I. General information

NPI: 1326780800
Provider Name (Legal Business Name): WENDY RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071
APO AP
96328-5071
US

IV. Provider business mailing address

UNIT 5071
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-7508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102208770
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: