Provider Demographics
NPI:1518924166
Name:BHANJI, WYLENE N (DO)
Entity Type:Individual
Prefix:DR
First Name:WYLENE
Middle Name:N
Last Name:BHANJI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12058 SAN JOSE BLVD STE 1004
Mailing Address - Street 2:CARING PHYSICAL REHABILITATION
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8667
Mailing Address - Country:US
Mailing Address - Phone:904-288-8060
Mailing Address - Fax:
Practice Address - Street 1:12058 SAN JOSE BLVD STE 1004
Practice Address - Street 2:CARING PHYSICAL REHABILITATION
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8667
Practice Address - Country:US
Practice Address - Phone:904-288-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9034207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37641OtherBCBS FL
FL268885900Medicaid
FL37641AMedicare PIN
FL268885900Medicaid