Healthcare Provider Details

I. General information

NPI: 1407816283
Provider Name (Legal Business Name): WENDY MYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 RIDGEWOOD AVE.
HOLLY HILL FL
32117
US

IV. Provider business mailing address

PO BOX 9671
DAYTONA BEACH FL
32120
US

V. Phone/Fax

Practice location:
  • Phone: 386-671-7100
  • Fax:
Mailing address:
  • Phone: 386-615-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME60910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: