Provider Demographics
NPI:1386810273
Name:MANCUSO, WENDY GAZA (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:GAZA
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:CHIEMI
Other - Last Name:GAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PSC 557 BOX 1930
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-0020
Mailing Address - Country:US
Mailing Address - Phone:315-645-9596
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL OKINAWA
Practice Address - Street 2:CAMP FOSTER BUILDING 972
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362-0020
Practice Address - Country:US
Practice Address - Phone:315-646-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602469662084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology