Provider Demographics
NPI:1033607700
Name:BERRY, WENDY MAYER (PA, MPH)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MAYER
Last Name:BERRY
Suffix:
Gender:F
Credentials:PA, MPH
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA, MPH
Mailing Address - Street 1:2000 WASHINGTON STREET
Mailing Address - Street 2:BLUE 201
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-965-4263
Mailing Address - Fax:
Practice Address - Street 1:2000 WASHINGTON STREET
Practice Address - Street 2:BLUE 201
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-965-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant