Provider Information for 1144613258
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AMY WALDIE
Sex: Female
NPI: 1144613258
Last Updated: 2015-03-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1144613258 | ||||||||
| Enumeration Date | 2015-03-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6009 PINE BLUFF LN MASCOTTE, FL 34753-8882 United States Phone: 352-408-8644 | Fax: | ||||||||
| Primary Practice Address | 1217 HUFFSTETLER RD EUSTIS, FL 32726-8225 United States Phone: 352-483-1652 | Fax:352-360-6582 | ||||||||
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