Healthcare Provider Details

I. General information

NPI: 1851598403
Provider Name (Legal Business Name): YUE M WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E NEW HAVEN AVE
MELBOURNE FL
32901-5427
US

IV. Provider business mailing address

502 E NEW HAVEN AVE
MELBOURNE FL
32901-5427
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-2020
  • Fax: 321-984-9547
Mailing address:
  • Phone: 321-727-2020
  • Fax: 321-984-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME107258
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD67525
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberME107258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: