Provider Demographics
NPI:1366647000
Name:WU, VELYN (MD)
Entity Type:Individual
Prefix:
First Name:VELYN
Middle Name:
Last Name:WU
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 1:1707 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3650
Mailing Address - Country:US
Mailing Address - Phone:352-265-7001
Mailing Address - Fax:352-265-9584
Practice Address - Street 1:1707 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3650
Practice Address - Country:US
Practice Address - Phone:352-265-7001
Practice Address - Fax:352-265-9584
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256131207Q00000X
FLME102446207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104824800Medicaid
BQ521ZMedicare PIN
FL11973OtherFHCP ID