Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southern Wellcare Medical PC

Organization Family Medicine Physician · NPI 1396090932

Southern Wellcare Medical PC is a Family Medicine Physician in Bronx, New York. Licensed in New York. Registered with an NPI since 2012.

Licensed in
NY
In the registry since
2012
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2336 Grand Concourse
Bronx, NY 10458-6903
Phone: (718) 907-0195
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 228243 (NY)

Record details

NPI number1396090932
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Svetlana Khandros — President · (718) 220-0439
NPI enumeratedJuly 19, 2012
Last updated in NPPESOctober 17, 2019
Mailing address2336 Grand Concourse, Bronx, NY 10458-6903

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