Provider Demographics
NPI:1588798037
Name:WELLS, ANASTASIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 GOLFSIDE VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2164
Mailing Address - Country:US
Mailing Address - Phone:407-880-8547
Mailing Address - Fax:407-880-8547
Practice Address - Street 1:1750 GOLFSIDE VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2164
Practice Address - Country:US
Practice Address - Phone:407-880-8547
Practice Address - Fax:407-880-8547
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical