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General NPI Number Information
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NPI Number | 1619064441
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Entity Type | Individual
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Provider Name | SHARON S FEDDERLY PHD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 5900 N. PORT WASHINGTON RD SUITE 230
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City | GLENDALE
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State | WI
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Zip | 53217
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Country | US
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Telephone | 414-962-4048
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Fax | 414-962-4052
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Provider Business Mailing Address
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Address Line | 5900 N. PORT WASHINGTON RD SUITE 230
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City | GLENDALE
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State | WI
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Zip | 53217
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Country | US
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Telephone | 414-962-4048
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Fax | 414-962-4052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1452-057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1452-57
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License Number State | WI
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