Provider Demographics
NPI:1790213692
Name:VILLANUEVA, WESLEY (PA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1221 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3520
Mailing Address - Country:US
Mailing Address - Phone:863-835-1562
Mailing Address - Fax:
Practice Address - Street 1:13275 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3984
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-905-8998
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2020-09-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant