Provider Demographics
NPI:1871479717
Name:MEDEROS-SEDANO, WENDI M
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:M
Last Name:MEDEROS-SEDANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 GRANARY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-3754
Mailing Address - Country:US
Mailing Address - Phone:775-357-5016
Mailing Address - Fax:
Practice Address - Street 1:1432 GRANARY PARK AVE
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-3754
Practice Address - Country:US
Practice Address - Phone:775-357-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV678156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician