Provider Demographics
NPI:1831329911
Name:MAYES-BEASLY, WENDY (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:MAYES-BEASLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5344 SACANDAGA ROAD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-0190
Mailing Address - Country:US
Mailing Address - Phone:518-882-6955
Mailing Address - Fax:518-882-9051
Practice Address - Street 1:5344 SACANDAGA ROAD
Practice Address - Street 2:
Practice Address - City:GALWAY
Practice Address - State:NY
Practice Address - Zip Code:12074-0190
Practice Address - Country:US
Practice Address - Phone:518-882-6955
Practice Address - Fax:518-882-9051
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257106207Q00000X
CO50209208M00000X
NY289513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist