Provider Demographics
NPI:1679635676
Name:PERROTT, WENDY SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SHARON
Last Name:PERROTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LAKESHORE POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5402
Mailing Address - Country:US
Mailing Address - Phone:352-483-3730
Mailing Address - Fax:352-508-9661
Practice Address - Street 1:1840 CLASSIQUE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5748
Practice Address - Country:US
Practice Address - Phone:352-483-3730
Practice Address - Fax:352-508-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66695207V00000X
FL66695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375664500Medicaid
FL25650AMedicare ID - Type UnspecifiedSOLO PROVIDER