Healthcare Provider Details

I. General information

NPI: 1922298363
Provider Name (Legal Business Name): WENDY LYN C ESTRELLADO-CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY STREET MSC 917, STE 570
CHARLESTON SC
29425-4619
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2007008746
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number91066
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: