Provider Demographics
NPI:1205099736
Name:WISHNEW, JESSICA MEREDITH (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MEREDITH
Last Name:WISHNEW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:6040 STATE ROAD 70 E UNIT B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9720
Practice Address - Country:US
Practice Address - Phone:941-366-2273
Practice Address - Fax:941-953-6500
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2020-01-16
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Provider Licenses
StateLicense IDTaxonomies
FLME120263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012335100Medicaid