Provider Demographics
NPI:1629409321
Name:CUSICK, WENDY (DVM)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:CUSICK
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 LAKE ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9551
Mailing Address - Country:US
Mailing Address - Phone:904-704-1468
Mailing Address - Fax:
Practice Address - Street 1:665 LAKE ASBURY DR
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-9551
Practice Address - Country:US
Practice Address - Phone:904-704-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM7450174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian