=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902288483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHE LING WONG MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2015
-----------------------------------------------------
Last Update Date | 06/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5130 LINTON BLVD SUITE E-2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484-6596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-330-4687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1558 NW 48TH PL
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-3339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-330-4687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHE LING WONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-330-4687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME111626
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------