Provider Demographics
NPI:1922139310
Name:WIELGUS, TAMMY (MS)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WIELGUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:21021 NE 21ST CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1619
Mailing Address - Country:US
Mailing Address - Phone:305-466-3384
Mailing Address - Fax:786-223-3519
Practice Address - Street 1:833 CHESTNUT ST STE 1250
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4413
Practice Address - Country:US
Practice Address - Phone:800-245-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96141170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS