WAYNE DIEDRICK PA
NPI 1083626386
Physician Assistant - Surgical in Hollywood, FL

Q: What is the provider's specialty?

The provider's specialty is Physician Assistant with taxonomy code 363AS0400X and a focus in Surgical.

Active since August 13, 2006

3501 JOHNSON ST, HOLLYWOOD, FL 33021(954) 987-2020 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Wayne Diedrick Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAYNE DIEDRICK PA (NPI 1083626386) is an individual surgical provider in Hollywood, Florida, licensed in Florida (PA3021) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1083626386

Entity TypeIndividualMale

Primary Taxonomy363AS0400X

Provider Legal NameWAYNE DIEDRICKCredential: PA

Location Address3501 JOHNSON STHollywood, FL 33021-5421

Mailing AddressPo Box 862233Orlando, FL 32886-2233 · (954) 276-5575

Phone(954) 987-2020

Sole ProprietorYes

Enumeration DateAugust 13, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1083626386 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in FL · PA3021

3501 JOHNSON ST, Hollywood, FL 33021

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Other Identifiers 1

Medicare ID-Type UnspecifiedE3875VFL

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARY K HAYES-MACALUSO M.D.

Radiology (Diagnostic Radiology)