Healthcare Provider Details

I. General information

NPI: 1003871286
Provider Name (Legal Business Name): SHUDONG WANG A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: SHUDONG WANG A.P.

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N OCEAN DR SUITE 206
FT LAUDERDALE FL
33308-5928
US

IV. Provider business mailing address

4001 N OCEAN DR SUITE 206
FT LAUDERDALE FL
33308-5928
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-9696
  • Fax: 954-772-9696
Mailing address:
  • Phone: 954-772-9696
  • Fax: 954-772-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 1272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: