| Doctor Name: | BAMBI LYNN WADELTON |
| NPI Number: | 1083764039 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PLHD |
| License Number: | PY5636 |
| Business Practice Address: | 13000 Sawgrass Village Cir Suite 46 Ponte Vedra Beach, FL - 320825016 |
| Business Phone Number: | 9042808555 |
| Business Fax Number: | 9042808562 |
| Mailing Address: | 13000 Sawgrass Village Cir, Suite 46 PONTE VEDRA BEACH |
| State: | FL |
| Postal Code: | 320825016 |
| Phone Number: | 9042808555 |
| Fax Number: | 9042808562 |
| NPI Enumeration Date: | 01/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY5636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |