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1679366918 NPI number — DAEMARI VAKARR WADE SR. ORTHODIC FITTER

NPI Number: 1679366918
Health Care Provider/Practitioner: DAEMARI VAKARR WADE SR. ORTHODIC FITTER

Information about “1679366918” NPI (DAEMARI VAKARR WADE SR. ORTHODIC FITTER) exists in 1679366918 in HTML format HTML  |  1679366918 in plain Text format TXT  |  1679366918 in PDF (Portable Document Format) PDF  |  1679366918 in an XML format XML  formats.

NPI Number : 1679366918 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679366918",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WADE",
    "FirstName": "DAEMARI",
    "MiddleName": "VAKARR",
    "NamePrefix": "MR.",
    "NameSuffix": "SR.",
    "Credential": "ORTHODIC FITTER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3334 CAPITAL MEDICAL BLVD STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TALLAHASSEE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32308-4470",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-877-8174",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3334 CAPITAL MEDICAL BLVD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TALLAHASSEE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32308-4470",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-877-8174",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/28/2025",
    "LastUpdateDate": "05/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "332B00000X",
        "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
        "LicenseNumber": "50-21938",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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