Individual
MRS. WANDA BANHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 376-1611
Mailing address
2327 WILSON ST, HOLLYWOOD, FL 33020-2652
(954) 801-4605
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 9105668
FL
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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