Provider Demographics
NPI:1356019426
Name:LAVEZZI, WENDY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:LAVEZZI
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 1:809 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6047
Mailing Address - Country:US
Mailing Address - Phone:352-326-5961
Mailing Address - Fax:
Practice Address - Street 1:809 PINE ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6047
Practice Address - Country:US
Practice Address - Phone:352-326-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100621207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology