Healthcare Provider Details

I. General information

NPI: 1487582003
Provider Name (Legal Business Name): WILNA MEDASTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BRICKELL AVE STE 430
MIAMI FL
33131-3152
US

IV. Provider business mailing address

3930 NW 32ND TER
LAUDERDALE LAKES FL
33309-4903
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone: 786-740-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: