Healthcare Provider Details

I. General information

NPI: 1396881777
Provider Name (Legal Business Name): WENDY LIGETI P.A,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

100 SOUTH ST
SOUTHBRIDGE MA
01550-4051
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9771
  • Fax: 508-764-2499
Mailing address:
  • Phone: 508-765-9771
  • Fax: 508-764-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA78
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: