Provider Demographics
NPI:1659928976
Name:WYNN, NATASHA OLIVIA RENE (AUD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:OLIVIA RENE
Last Name:WYNN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:OLIVIA RENE
Other - Last Name:GASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:226 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 WELLNESS WAY STE 300
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4366
Practice Address - Country:US
Practice Address - Phone:302-393-5009
Practice Address - Fax:302-424-9211
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE02-0000250231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist