Provider Demographics
NPI:1669667572
Name:WONG, AURORA CLAUDINE (MD)
Entity Type:Individual
Prefix:MRS
First Name:AURORA
Middle Name:CLAUDINE
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AURORA
Other - Middle Name:CLAUDINE
Other - Last Name:LUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8350 BEE RIDGE RD
Mailing Address - Street 2:# 288
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-6312
Mailing Address - Country:US
Mailing Address - Phone:941-315-8090
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:8350 BEE RIDGE RD
Practice Address - Street 2:# 288
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-6312
Practice Address - Country:US
Practice Address - Phone:941-315-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43701208100000X
MA2335072081S0010X
FLME131855208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA889220886OtherTUFTS EPO PLAN