Provider Demographics
NPI:1710151162
Name:WADMAN, SHARI J (PA)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:J
Last Name:WADMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 W ANTHEM WAY UNIT 2011
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3129
Mailing Address - Country:US
Mailing Address - Phone:805-341-6956
Mailing Address - Fax:
Practice Address - Street 1:3825 W ANTHEM WAY UNIT 2011
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3129
Practice Address - Country:US
Practice Address - Phone:805-341-6956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8219363A00000X
CA19177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant