Healthcare Provider Details

I. General information

NPI: 1902288483
Provider Name (Legal Business Name): SHE LING WONG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD SUITE E-2
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

1558 NW 48TH PL
BOCA RATON FL
33431-3339
US

V. Phone/Fax

Practice location:
  • Phone: 561-330-4687
  • Fax:
Mailing address:
  • Phone: 561-330-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME111626
License Number StateFL

VIII. Authorized Official

Name: DR. SHE LING WONG
Title or Position: OWNER
Credential: MD
Phone: 561-330-4687