Provider Demographics
NPI:1134325731
Name:EVERLETH, WENDY LYN (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYN
Last Name:EVERLETH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-2544
Mailing Address - Country:US
Mailing Address - Phone:315-732-6962
Mailing Address - Fax:
Practice Address - Street 1:6313 HIDDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2544
Practice Address - Country:US
Practice Address - Phone:315-732-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180377207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology