MEDICARE: MR. CHRISTOPHER J WIEDEMANN

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	103K00000X	Behavior Analyst

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	:	1902447006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER J WIEDEMANN

Provider Business Mailing Address
First Line	:	1780 ROCKY WOOD CIR APT 125
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6580
Country	:	US
Telephone Number	:	502-389-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 ROCKY WOOD CIR APT 125
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6580
Country	:	US
Telephone Number	:	502-389-0580
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	01/13/2021

Similar Medicare Providers

1336156413 — WALGREEN CO
Practice Location Address:

3799 MURRELL RD
ROCKLEDGE, FL
32955-4710

Practice Phone: 321-631-2755
Practice Fax:

1811994270 — VNA SPACE COAST, INC.
Practice Location Address:

391 COMMERCE PKWY STE 240-260
ROCKLEDGE, FL
32955-4209

Practice Phone: 772-567-5551
Practice Fax: 772-569-1444

1730952334 — SEAN MCKEEL
Practice Location Address:

1026 PATHFINDER WAY
ROCKLEDGE, FL
32955-3216

Practice Phone: 321-655-5880
Practice Fax: 317-520-8200

1841157864 — NYIANNI MATHIS RBT
Practice Location Address:

897 YORKTOWNE DR
ROCKLEDGE, FL
32955-8106

Practice Phone: 321-541-1970
Practice Fax:

1164439246 — WALGREEN CO
Practice Location Address:

5475 MURRELL RD
ROCKLEDGE, FL
32955-6665

Practice Phone: 321-631-3732
Practice Fax:

1669475497 — DR. PARWATI C MADDALI M.D.
Practice Location Address:

845 EXECUTIVE LN , 100
ROCKLEDGE, FL
32955-3528

Practice Phone: 321-631-4222
Practice Fax: 321-631-4302

Directions to “ MR. CHRISTOPHER J WIEDEMANN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.