Healthcare Provider Details

I. General information

NPI: 1558321174
Provider Name (Legal Business Name): WYNNE SHIU LEE-NUNEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S KANNER HWY
STUART FL
34994
US

IV. Provider business mailing address

1815 S KANNER HWY
STUART FL
34994-7204
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2992
  • Fax:
Mailing address:
  • Phone: 772-288-2992
  • Fax: 772-288-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME80200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: