Provider Demographics
NPI:1639462419
Name:PALASTRO, WENDY HEROLD (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:HEROLD
Last Name:PALASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E GIRARD AVE STE 27046
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1440 W TAYLOR ST STE 227
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4623
Practice Address - Country:US
Practice Address - Phone:888-805-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD85437207Q00000X
NY294120207Q00000X
NC2023-00840207Q00000X
MI4301115462207Q00000X
NJ25MA11907100207Q00000X
GA98619207Q00000X
VA0101276813207Q00000X
MA275516207Q00000X
FLME136342207Q00000X
MN73091207Q00000X
MO2022041313207Q00000X
CAC184245207Q00000X
ARE-15932207Q00000X
PAMD451765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine