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General NPI Number Information
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NPI Number | 1376981688
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Entity Type | Individual
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Provider Name | CANDACE WONSEY
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Gender | Female
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Dates
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Enumeration Date | 06/08/2013
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Last Update Date | 11/11/2018
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Provider Practice Location Address
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Address Line | 2327 WINDING CV
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City | OVIEDO
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State | FL
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Zip | 32765-6376
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Country | US
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Telephone | 407-758-8298
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Fax |
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Provider Business Mailing Address
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Address Line | 11140 RUNNING PINE DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-2212
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Country | US
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Telephone | 407-758-8298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CL1208534
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License Number State | FL
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