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General NPI Number Information
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NPI Number | 1760962286
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Entity Type | Individual
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Provider Name | SHEKIAH WAGNER
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 8362 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6600
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Country | US
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Telephone | 954-364-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 4878 OLD BAINBRIDGE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32303-7210
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Country | US
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Telephone | 954-558-2736
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT5172
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License Number State | FL
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