Provider Demographics
NPI:1770784647
Name:WAGLE, ANAGHA S (BSCOT)
Entity type:Individual
Prefix:
First Name:ANAGHA
Middle Name:S
Last Name:WAGLE
Suffix:
Gender:F
Credentials:BSCOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 BREAM AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1012
Mailing Address - Country:US
Mailing Address - Phone:863-314-0214
Mailing Address - Fax:
Practice Address - Street 1:5959 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2075
Practice Address - Country:US
Practice Address - Phone:863-471-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-4560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist