Ann Marie Deveras Wong, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME 108078 Issued in FL

Practice address

1801 NE 123Rd St
Suite 414
North Miami, FL 33181-2817

Phone

(305) 981-0600

Fax

(305) 981-2700

NPI assigned

Oct 17, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Golden Age Mental Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cape Coral, FL
  • NPI 1497649032
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1093704769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 NE 54TH ST STE 7",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331372966",
            "telephone_number": "786-842-7001",
            "fax_number": "786-410-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 NE 123RD ST",
            "address_2": "SUITE 414",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331812817",
            "telephone_number": "305-981-0600",
            "fax_number": "305-981-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "ANN MARIE",
        "middle_name": "DEVERAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-17",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "204659",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME 108078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002812400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmanuela Henriette Wolloch, M.D.
• Women'S Health / Natural Care
• Wonderful Counselor LLC
• Wonderland Behavior Services LLC
• Wonderland Therapy Services LLC
• Emily Jeanne Wutz, OTR/L
• Xavier International Laboratories
• Anne Xavier
• Yaimilyn Alonso Counseling LLC
• Sivan Yechezkel, LCSW

• Pediatrics Physician in North Miami, FL
• Providers in North Miami, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.