Healthcare Provider Details

I. General information

NPI: 1184326589
Provider Name (Legal Business Name): WHA WOUND CARE FLA PC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8052 NW 161ST TER
MIAMI LAKES FL
33016-6655
US

IV. Provider business mailing address

8004 NW 154TH ST STE 661
MIAMI LAKES FL
33016-5814
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-9200
  • Fax:
Mailing address:
  • Phone: 973-427-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SEKULEO GATHERS
Title or Position: OWNER
Credential: MD
Phone: 973-427-9200