Provider Demographics
NPI:1477584076
Name:MAYS, WENDELLENNA SUESANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELLENNA
Middle Name:SUESANNA
Last Name:MAYS
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 1:3130 CITRUS TOWER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6801
Mailing Address - Country:US
Mailing Address - Phone:352-404-6900
Mailing Address - Fax:352-404-6904
Practice Address - Street 1:3130 CITRUS TOWER BLVD STE A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-404-6900
Practice Address - Fax:352-404-6904
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266115200Medicaid
FL266115200Medicaid
FLH42464Medicare UPIN