Healthcare Provider Details

I. General information

NPI: 1730382284
Provider Name (Legal Business Name): SHERI LYNN WAGNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-0225
  • Fax: 716-323-0293
Mailing address:
  • Phone: 716-323-0034
  • Fax: 716-323-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number244296
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number244296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: