MEDICARE: DR. MYRA WAYNIK 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	207Q00000X	Family Medicine Physician	019920	CT

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

General Provider Information

NPI Number	:	1841259827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRA WAYNIK M.D.

Provider Business Mailing Address
First Line	:	3715 MAIN ST
Second Line	:	SUITE 200
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-3618
Country	:	US
Telephone Number	:	203-372-4065
Fax Number	:	203-372-1644

Provider Business Practice Location Address
First Line	:	3715 MAIN ST
Second Line	:	SUITE 200
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-3618
Country	:	US
Telephone Number	:	203-372-4065
Fax Number	:	203-372-1644

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	05/31/2013

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