Provider Demographics
NPI:1376384966
Name:WILDWOOD FAMILY PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:WILDWOOD FAMILY PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-535-8110
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-0356
Mailing Address - Country:US
Mailing Address - Phone:352-535-8110
Mailing Address - Fax:
Practice Address - Street 1:900 CLEVELAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3506
Practice Address - Country:US
Practice Address - Phone:352-535-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty