Provider Demographics
NPI:1255899431
Name:WENDE, ALEXANDRA (MS ED)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WENDE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4333
Mailing Address - Country:US
Mailing Address - Phone:716-515-5477
Mailing Address - Fax:
Practice Address - Street 1:51 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4333
Practice Address - Country:US
Practice Address - Phone:716-515-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2610800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist