Provider Demographics
NPI:1679366918
Name:WADE, DAEMARI VAKARR SR (ORTHODIC FITTER)
Entity type:Individual
Prefix:MR
First Name:DAEMARI
Middle Name:VAKARR
Last Name:WADE
Suffix:SR
Gender:M
Credentials:ORTHODIC FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 CAPITAL MEDICAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4470
Mailing Address - Country:US
Mailing Address - Phone:850-877-8174
Mailing Address - Fax:
Practice Address - Street 1:3334 CAPITAL MEDICAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4470
Practice Address - Country:US
Practice Address - Phone:850-877-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50-21938332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies