=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053554717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY S WANG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2009
-----------------------------------------------------
Last Update Date | 09/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N CATTLEMEN RD STE 200
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-377-9993
-----------------------------------------------------
Fax | 941-343-0026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 102222
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30368-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-432-8336
-----------------------------------------------------
Fax | 239-278-3350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | ME123610
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------