Organization
CHERYL REILLY-WONG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN SULLIVAN (ADMINISTRATIVE ASSISTANT I)
(772) 462-3922
Entity
Organization
Contact information
Practice address
5150 NW MILNER DR, PORT ST LUCIE, FL 34983-3392
(772) 462-3800
Mailing address
5150 NW MILNER DR, PORT ST LUCIE, FL 34983-3392
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
RN9220511
FL
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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