Provider Demographics
NPI:1508075276
Name:WAGLE, SHEETAL HARISH (MD, MBBS)
Entity Type:Individual
Prefix:
First Name:SHEETAL
Middle Name:HARISH
Last Name:WAGLE
Suffix:
Gender:F
Credentials:MD, MBBS
Other - Prefix:
Other - First Name:SHEETAL
Other - Middle Name:JAGDISH
Other - Last Name:KAMAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MBBS
Mailing Address - Street 1:10770 HICKORY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3646
Mailing Address - Country:US
Mailing Address - Phone:410-988-4013
Mailing Address - Fax:
Practice Address - Street 1:10770 HICKORY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3646
Practice Address - Country:US
Practice Address - Phone:410-988-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00721062084N0600X, 2084N0400X
VA0116018133390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program