Provider Demographics
NPI:1760903538
Name:WULFF, CANDACE RAQUEL (DO)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:RAQUEL
Last Name:WULFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1801 SUNSET DRIVE
Mailing Address - Street 2:SURGERY CLINIC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6155
Mailing Address - Fax:803-434-4183
Practice Address - Street 1:1801 SUNSET DRIVE
Practice Address - Street 2:SURGERY CLINIC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-4183
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL51258208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery