Provider Demographics
NPI:1700063443
Name:SOSA, WENDY GENTILE (LMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:GENTILE
Last Name:SOSA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 S OCEAN DR
Mailing Address - Street 2:1209
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2831
Mailing Address - Country:US
Mailing Address - Phone:954-257-3663
Mailing Address - Fax:
Practice Address - Street 1:3505 S. OCEAN DRIVE
Practice Address - Street 2:1209
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019
Practice Address - Country:US
Practice Address - Phone:954-257-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38843171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor