Healthcare Provider Details

I. General information

NPI: 1710151162
Provider Name (Legal Business Name): SHARI J WADMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOULTON ST
PATTEN ME
04765-3035
US

IV. Provider business mailing address

3825 W ANTHEM WAY UNIT 2011
ANTHEM AZ
85086-3129
US

V. Phone/Fax

Practice location:
  • Phone: 805-341-6956
  • Fax:
Mailing address:
  • Phone: 805-341-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1402
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: