Provider Demographics
NPI:1336786508
Name:OCCIDE, WENDA
Entity type:Individual
Prefix:MS
First Name:WENDA
Middle Name:
Last Name:OCCIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDA
Other - Middle Name:
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11036 LITTLE BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2418
Mailing Address - Country:US
Mailing Address - Phone:786-351-1265
Mailing Address - Fax:
Practice Address - Street 1:11036 LITTLE BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2418
Practice Address - Country:US
Practice Address - Phone:786-351-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician