Healthcare Provider Details

I. General information

NPI: 1003208554
Provider Name (Legal Business Name): JESSICA EMILIA WAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

1030 9TH ST APT 202
MIAMI BEACH FL
33139-5601
US

V. Phone/Fax

Practice location:
  • Phone: 304-545-3095
  • Fax:
Mailing address:
  • Phone: 304-545-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME162126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: