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Individual
WYLDER SHEPHERD FONDAW
Active
Individual
WYLDER SHEPHERD FONDAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-10234
NC
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
06/03/2020
Last updated
07/18/2023
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