Provider Demographics
NPI:1033885421
Name:RAY, WANDARDA
Entity Type:Individual
Prefix:
First Name:WANDARDA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 MISS MUFFET LN S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3636
Mailing Address - Country:US
Mailing Address - Phone:904-738-3328
Mailing Address - Fax:
Practice Address - Street 1:6755 MISS MUFFET LN S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3636
Practice Address - Country:US
Practice Address - Phone:904-738-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services