Provider Demographics
NPI:1679798128
Name:SLONE, WENDELL (DO)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:
Last Name:SLONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 PGA BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3912
Mailing Address - Country:US
Mailing Address - Phone:561-622-1388
Mailing Address - Fax:561-622-2408
Practice Address - Street 1:4530 PGA BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3912
Practice Address - Country:US
Practice Address - Phone:561-622-1388
Practice Address - Fax:561-622-2408
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4347156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician