Provider Demographics
NPI:1467717694
Name:NORWOOD, WANDA MICHELE
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:MICHELE
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:MICHELE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:695 BELMONT AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4425
Mailing Address - Country:US
Mailing Address - Phone:718-235-4149
Mailing Address - Fax:
Practice Address - Street 1:156 BEACH 6TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1421
Practice Address - Country:US
Practice Address - Phone:347-369-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist