Individual
DR. CASSAUNDRA TENNILLE WIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
7451 RIVIERA BLVD STE 120, MIRAMAR, FL 33023-6569
(305) 918-2588
(305) 974-1360
Mailing address
7451 RIVIERA BLVD STE 120, MIRAMAR, FL 33023-6569
(305) 918-2588
(305) 974-1360
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 8192
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003127500
—
FL
05
—
013070800
—
FL
Enumeration date
08/21/2007
Last updated
12/13/2022
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