Provider Demographics
NPI:1972009066
Name:FERREIRA, WICKANDER (MLT (ASCP)CM)
Entity type:Individual
Prefix:MR
First Name:WICKANDER
Middle Name:
Last Name:FERREIRA
Suffix:
Gender:M
Credentials:MLT (ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 W DIXIE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2059
Mailing Address - Country:US
Mailing Address - Phone:305-704-8503
Mailing Address - Fax:
Practice Address - Street 1:18100 W DIXIE HWY STE 205
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2059
Practice Address - Country:US
Practice Address - Phone:305-704-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RM2200X
FLTC52623246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty