Provider Demographics
NPI:1326215278
Name:WELLS, SARAN AYANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAN
Middle Name:AYANNA
Last Name:WELLS
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:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-633-0820
Mailing Address - Fax:904-633-0821
Practice Address - Street 1:4215 PLANTATION OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3641
Practice Address - Country:US
Practice Address - Phone:904-633-0820
Practice Address - Fax:904-633-0821
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME124409208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program