Provider Demographics
NPI:1548521677
Name:CAESAR, WYNETTE VIRGINIA (MSED)
Entity type:Individual
Prefix:
First Name:WYNETTE
Middle Name:VIRGINIA
Last Name:CAESAR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3248
Mailing Address - Country:US
Mailing Address - Phone:646-345-3789
Mailing Address - Fax:
Practice Address - Street 1:559 E 85TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3248
Practice Address - Country:US
Practice Address - Phone:646-345-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY830225742OtherNYS LEARNERS PERMIT