Provider Demographics
NPI:1932216496
Name:BERRIOS, WANDA M (MD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:M
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3050 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1544
Practice Address - Country:US
Practice Address - Phone:407-343-8335
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR13686208D00000X
FLACN699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN 699OtherFLORIDA MEDICAL LICENSE