Healthcare Provider Details

I. General information

NPI: 1205099736
Provider Name (Legal Business Name): JESSICA M. WISHNEW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 59TH STREET WEST
BRADENTON FL
34209
US

IV. Provider business mailing address

1414 59TH STREET WEST
BRADENTON FL
34209
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-0663
  • Fax: 941-761-3347
Mailing address:
  • Phone: 941-761-0663
  • Fax: 941-761-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME120263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: