Healthcare Provider Details

I. General information

NPI: 1558068650
Provider Name (Legal Business Name): KAITLYN WENDLING ROSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLYN G WENDLING

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WINDERLEY PL STE 115
MAITLAND FL
32751-7406
US

IV. Provider business mailing address

500 WINDERLEY PL STE 115
MAITLAND FL
32751-7406
US

V. Phone/Fax

Practice location:
  • Phone: 407-284-9777
  • Fax:
Mailing address:
  • Phone: 407-284-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: