Individual
WANDA MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1445 S LAWRENCE BLVD, KEYSTONE HEIGHTS, FL 32656-9349
(352) 448-9843
(888) 213-4424
Mailing address
PO BOX 82, KEYSTONE HEIGHTS, FL 32656-0082
(352) 448-9843
(888) 213-4424
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2016
Last updated
11/02/2016
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