Provider Demographics
NPI:1396033973
Name:ROY, WENDY LEE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:ROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 HIGHWAY 348
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-6195
Mailing Address - Country:US
Mailing Address - Phone:843-333-2846
Mailing Address - Fax:843-756-2897
Practice Address - Street 1:1616 HIGHWAY 348
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-6195
Practice Address - Country:US
Practice Address - Phone:843-333-2846
Practice Address - Fax:843-756-2897
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4676175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath