| Doctor Name: | LINDA WYNNE |
| NPI Number: | 1043231699 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPAC |
| License Number: | 006266-1 |
| Business Practice Address: | 815 Hallock Ave Port Jefferson Station, NY - 117761220 |
| Business Phone Number: | 6313317267 |
| Business Fax Number: | |
| Mailing Address: | 22 Silas Woods Rd, MANORVILLE |
| State: | NY |
| Postal Code: | 119493053 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/21/2006 |
| NPI Last Update Date: | 09/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 006266-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |