Provider Demographics
NPI:1902066368
Name:WAYNE N EVANCHO DO PA
Entity Type:Organization
Organization Name:WAYNE N EVANCHO DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-944-8777
Mailing Address - Street 1:5811 CASTLEGATE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3236
Mailing Address - Country:US
Mailing Address - Phone:305-944-8777
Mailing Address - Fax:305-944-3006
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 285
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-944-8777
Practice Address - Fax:305-944-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty