MEDICARE: AILINA WUNDERLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1073455580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILINA WUNDERLY

Provider Business Mailing Address
First Line	:	1555 CHERRY ST APT 3
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-3093
Country	:	US
Telephone Number	:	269-903-8790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 CHERRY ST APT 3
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-3093
Country	:	US
Telephone Number	:	269-903-8790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ AILINA WUNDERLY ” Practice Location

Language	Start Address	Practice Location

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