Healthcare Provider Details

I. General information

NPI: 1356019426
Provider Name (Legal Business Name): WENDY ANN LAVEZZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 PINE ST
LEESBURG FL
34748-6047
US

IV. Provider business mailing address

809 PINE ST
LEESBURG FL
34748-6047
US

V. Phone/Fax

Practice location:
  • Phone: 352-326-5961
  • Fax:
Mailing address:
  • Phone: 352-326-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME100621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: