Active NPI
Wanda Mayberry
- Developmental Disabilities Clinic/Center
- Keystone Heights, FL
National Provider Identifier
1497206189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Disabilities Clinic/Center
- Practice address
- 1445 S Lawrence Blvd
Keystone Heights, FL 32656-9349 - Phone
- (352) 448-9843
- Fax
- (888) 213-4424
- NPI assigned
- Oct 18, 2016
- Last updated
- Nov 2, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | Primary |
Addresses
Primary practice location
1445 S Lawrence Blvd
Keystone Heights, FL 32656-9349
Mailing address
PO Box 82
Keystone Heights, FL 32656-0082
Phone (352) 448-9843
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478044800000",
"number": "1497206189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 82",
"city": "KEYSTONE HEIGHTS",
"state": "FL",
"postal_code": "326560082",
"telephone_number": "352-448-9843",
"fax_number": "888-213-4424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 S LAWRENCE BLVD",
"city": "KEYSTONE HEIGHTS",
"state": "FL",
"postal_code": "326569349",
"telephone_number": "352-448-9843",
"fax_number": "888-213-4424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYBERRY",
"first_name": "WANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-18",
"last_updated": "2016-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keystone Heights, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.