Healthcare Provider Details

I. General information

NPI: 1023289212
Provider Name (Legal Business Name): WUNDERMAN & WUNDERMAN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SW 92ND ST SUITE 203
MIAMI FL
33156-7397
US

IV. Provider business mailing address

8600 SW 92ND ST SUITE 203
MIAMI FL
33156-7397
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-6633
  • Fax: 305-385-7164
Mailing address:
  • Phone: 305-595-6633
  • Fax: 305-385-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY4278
License Number StateFL

VIII. Authorized Official

Name: DR. TERILEE WUNDERMAN
Title or Position: VICE PRESIDENT
Credential: PH.D.
Phone: 305-595-6633