Provider Demographics
NPI:1033916093
Name:WAKIM, CYNTHIA SIMON (PA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SIMON
Last Name:WAKIM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 KNOTT DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6447
Mailing Address - Country:US
Mailing Address - Phone:407-325-5251
Mailing Address - Fax:
Practice Address - Street 1:1900 DON WICKHAM DR STE 127
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:407-648-5384
Practice Address - Fax:321-843-6975
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9119896363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant