Provider Demographics
NPI:1013270859
Name:WILEY, MYRNA CAROL (MSED)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:CAROL
Last Name:WILEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1900 SW 163RD PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-7215
Mailing Address - Country:US
Mailing Address - Phone:352-347-2685
Mailing Address - Fax:352-347-2685
Practice Address - Street 1:4302 NEW UTRECHT AVE.
Practice Address - Street 2:INDEPENDENT S.I. CONTRACTOR WITH HEAR OUR VOICES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-686-9600
Practice Address - Fax:718-686-6161
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYPROV ID: 16121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist