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General NPI Number Information
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NPI Number | 1124534342
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Entity Type | Organization
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Legal Business Name | WEPELLET BRADENTON LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 1003 8TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-7709
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Country | US
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Telephone | 833-937-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 8TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-7709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | JACLYN SHEDDEN
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Credential | ARNP
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Telephone | 833-939-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0S10018
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License Number State | FL
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