Provider Information for 1336664572
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ROSHELLE MAE WILDER MSW
Sex: Female
NPI: 1336664572
Last Updated: 2017-08-09
Certification Date:
Certification Date:
Details
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NPI | 1336664572 | ||||||||
Enumeration Date | 2017-08-09 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 2801 NE 183RD ST AVENTURA, FL 33160-2100 United States Phone: | Fax: | ||||||||
Primary Practice Address | 1825 NW 167TH ST STE 102 MIAMI GARDENS, FL 33056-4838 United States Phone: 305-624-7450 | Fax: | ||||||||
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