Healthcare Provider Details

I. General information

NPI: 1043040868
Provider Name (Legal Business Name): WEDNIE PHILOXY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 METROCENTER BLVD STE 350
ORLANDO FL
32835-7642
US

IV. Provider business mailing address

8513 WHITE ROSE DR
ORLANDO FL
32818-5678
US

V. Phone/Fax

Practice location:
  • Phone: 877-685-2783
  • Fax:
Mailing address:
  • Phone: 407-725-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-281999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: