Provider Demographics
NPI:1033902184
Name:WEDDERBURN, KAYDIAN SUZZETTE
Entity type:Individual
Prefix:MS
First Name:KAYDIAN
Middle Name:SUZZETTE
Last Name:WEDDERBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 CYPRESS FOX BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-9512
Mailing Address - Country:US
Mailing Address - Phone:615-752-1729
Mailing Address - Fax:
Practice Address - Street 1:1070 CYPRESS FOX BLVD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-9512
Practice Address - Country:US
Practice Address - Phone:615-752-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95259481163W00000X
NV873691163W00000X
FLRN9587455163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse