Provider Demographics
NPI:1699362988
Name:DELANEY, WENDY LYNN
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:DELANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22370 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5382
Mailing Address - Country:US
Mailing Address - Phone:703-466-4900
Mailing Address - Fax:
Practice Address - Street 1:22370 DAVIS DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5382
Practice Address - Country:US
Practice Address - Phone:703-466-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02026766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1234Medicaid