Provider Demographics
NPI:1396269981
Name:GOLFO, WENDY LEIGH PALLONE (DOM, AP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LEIGH PALLONE
Last Name:GOLFO
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SEATTLE TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5530
Mailing Address - Country:US
Mailing Address - Phone:386-237-8714
Mailing Address - Fax:
Practice Address - Street 1:214 MOODY BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3372
Practice Address - Country:US
Practice Address - Phone:386-439-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3715171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist