Healthcare Provider Details

I. General information

NPI: 1538206792
Provider Name (Legal Business Name): WENDY L MCQUEEN MIYA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
MIAMI FL
33190-1003
US

IV. Provider business mailing address

9299 SW 166TH ST
VILLAGE OF PALMETTO BAY FL
33157-3446
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax:
Mailing address:
  • Phone: 305-253-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9238936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: