Provider Demographics
NPI:1851758528
Name:WAGNER, SHARI (MS, ATC)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6700
Mailing Address - Country:US
Mailing Address - Phone:215-680-5500
Mailing Address - Fax:
Practice Address - Street 1:3 CLOVER CT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6700
Practice Address - Country:US
Practice Address - Phone:215-680-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer