Provider Demographics
NPI:1710344734
Name:PHILLIPS, WENDY YVONNE
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:YVONNE
Last Name:PHILLIPS
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 1:956 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3432
Mailing Address - Country:US
Mailing Address - Phone:718-610-9156
Mailing Address - Fax:
Practice Address - Street 1:956 E 37TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3432
Practice Address - Country:US
Practice Address - Phone:718-610-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist