Provider Demographics
NPI:1932453271
Name:DEVITIS, WENDY WILLIAMS (MED)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:WILLIAMS
Last Name:DEVITIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:THERESE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1302 RHODE ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3843
Mailing Address - Country:US
Mailing Address - Phone:610-780-6475
Mailing Address - Fax:
Practice Address - Street 1:455 BOOT RD
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3043
Practice Address - Country:US
Practice Address - Phone:484-237-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5108615304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist