Individual
WANDA LAI FUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5105 N ARMENIA AVE, TAMPA, FL 33603-1405
(813) 879-8045
(813) 876-6504
Mailing address
5105 N ARMENIA AVE, TAMPA, FL 33603-1405
(813) 879-8045
(813) 876-6504
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
66256
MN
207Y00000X
Otolaryngology Physician
Primary
ME163082
FL
Other
Enumeration date
03/31/2018
Last updated
01/22/2024
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