MEDICARE: MISS WAYNE M NEVALA M.D.

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	207P00000X	Emergency Medicine Physician	O34426	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194713289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS WAYNE M NEVALA M.D.

Provider Business Mailing Address
First Line	:	500 WINDERLEY PL
Second Line	:	SUITE 115
City	:	MAITLAND
State	:	FL
Zip	:	32751-7247
Country	:	US
Telephone Number	:	404-875-8784
Fax Number	:	404-875-0244

Provider Business Practice Location Address
First Line	:	1000 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5266
Country	:	US
Telephone Number	:	352-253-3333
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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