Provider Demographics
NPI:1801877253
Name:DORAN, WENDY ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ELLEN
Last Name:DORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W CAMINO GARDENS BOULEVARD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-620-2612
Mailing Address - Fax:561-620-2614
Practice Address - Street 1:370 W CAMINO GARDENS BOULEVARD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-620-2612
Practice Address - Fax:561-620-2614
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME761962084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39270Medicare UPIN
FL43834Medicare PIN