Provider Demographics
NPI:1144379710
Name:HENAO, WANDA (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:HENAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR STE 135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2401
Mailing Address - Country:US
Mailing Address - Phone:713-467-2800
Mailing Address - Fax:713-467-2892
Practice Address - Street 1:902 FROSTWOOD DR STE 135
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2401
Practice Address - Country:US
Practice Address - Phone:713-467-2800
Practice Address - Fax:713-467-2892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD665342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00505FMedicare ID - Type Unspecified
TXD66534Medicare UPIN