Provider Demographics
NPI:1518670660
Name:DESHOMMES, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:DESHOMMES
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 1:111 W CENTRAL AVE UNIT 1324
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33882-7054
Mailing Address - Country:US
Mailing Address - Phone:863-651-5315
Mailing Address - Fax:
Practice Address - Street 1:705 HEMENWAY DR NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2700
Practice Address - Country:US
Practice Address - Phone:863-651-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company