Wendell Damyeon Wallace-Juedes, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

2407 Issued in MA

Practice address

386 Merrimack St
Suite 1B
Methuen, MA 01844-5802

Phone

(978) 682-0382

Fax

(978) 975-3585

NPI assigned

Apr 19, 2011

Last updated

Mar 10, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1285924696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "386 MERRIMACK ST",
            "address_2": "SUITE 1B",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018445802",
            "telephone_number": "978-682-0382",
            "fax_number": "978-975-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 MERRIMACK ST",
            "address_2": "SUITE 1B",
            "city": "METHUEN",
            "state": "MA",
            "postal_code": "018445802",
            "telephone_number": "978-682-0382",
            "fax_number": "978-975-3585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-JUEDES",
        "first_name": "WENDELL",
        "middle_name": "DAMYEON",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-19",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MA",
            "license": "2407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Methuen, MA
• Providers in Methuen, MA by specialty
• Podiatrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.