Provider Demographics
NPI:1649200825
Name:DE SILVA, WENDY WANG (GNP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:WANG
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7758 WISCONSIN AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3530
Mailing Address - Country:US
Mailing Address - Phone:301-530-3237
Mailing Address - Fax:301-907-4590
Practice Address - Street 1:7758 WISCONSIN AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3530
Practice Address - Country:US
Practice Address - Phone:301-530-3237
Practice Address - Fax:301-907-4590
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471109363L00000X
MDR175265363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051012200Medicaid
0060OtherBCBS DC
0943SE-891740-02OtherCAREFIRST BCBS OF MD
522096682004OtherTRICARE NORTH
89174002OtherCAREFIRST MD
9680-0048OtherCAREFIRST BCBS OF DC
CAWNP11075BOtherPPIN
0060OtherBCBS OF DC
0943ER-891740-02OtherCAREFIRST BCBS OF MD
8307572OtherEVERCARE
P00612407Medicare PIN
9680-0048OtherCAREFIRST BCBS OF DC