Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY0004543 | FL |
Y | 103TC0700X | Clinical Psychologist | PY0004543 | FL |
NPI | 1003934910 |
---|---|
Provider Name | Dr. Steven Fei Wu |
First Address | Valrico, FL 33595-0189 |
Second Address | Brandon, FL 33510-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 26/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73777 | BLUE CROSS BLUE SHIELD (01) | FL |