Active NPI
Wendy Mae Fedoronko
- Physical Therapy Assistant
- Wilmington, DE
National Provider Identifier
1811570195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- J2-0000460
- Practice address
- 704 River Rd
Wilmington, DE 19809-2746 - Phone
- (302) 764-7000
- NPI assigned
- May 4, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | J2-0000460 | DE | Primary |
Addresses
Primary practice location
704 River Rd
Wilmington, DE 19809-2746
Mailing address
2600 Compass Rd
Glenview, IL 60026-8001
Phone (877) 787-3422
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J2-0000460 | DE | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1811570195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 COMPASS RD",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600268001",
"telephone_number": "877-787-3422",
"fax_number": "847-441-4130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 RIVER RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198092746",
"telephone_number": "302-764-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDORONKO",
"first_name": "WENDY",
"middle_name": "MAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-04",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "DE",
"license": "J2-0000460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.