Provider Demographics
NPI:1518232768
Name:WANDER, SHARON ANITA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANITA
Last Name:WANDER
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 1:52 BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINTOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 S WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-301-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041787E208000000X
PAMD041787-E208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice