Individual
CRISTY A WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
521 WEST STATE ROAD 434, SUITE 101 PEDIATRIC, & ADOLESCENT MED OF SEMINOLE, IIN ASSOC WITH NEMOURS, LONGWOOD, FL 32750-4952
(407) 830-5437
(407) 830-4907
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-4488
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME105408
FL
208D00000X
General Practice Physician
Primary
ME105408
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
'001444100
—
FL
Enumeration date
09/01/2009
Last updated
10/09/2014
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