Provider Demographics
NPI:1164536835
Name:ROMERO, WANDA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:L
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10874 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1364
Mailing Address - Country:US
Mailing Address - Phone:305-270-7440
Mailing Address - Fax:305-461-4077
Practice Address - Street 1:782 NW 42ND AVE STE 334
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5550
Practice Address - Country:US
Practice Address - Phone:305-461-4684
Practice Address - Fax:305-461-4077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5002103T00000X
FLPY 5002103TC0700X, 103T00000X, 103TF0200X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59551Medicare PIN