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General NPI Number Information
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NPI Number | 1811107683
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Entity Type | Individual
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Provider Name | SHARON SANBORN WAGAMON MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 870 W MAIN ST
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City | GENEVA
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State | OH
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Zip | 44041-1219
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Country | US
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Telephone | 440-415-0158
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Fax | 216-201-8172
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Provider Business Mailing Address
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Address Line | 19151 NELSON PARKMAN RD
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City | GARRETTSVILLE
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State | OH
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Zip | 44231-9559
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Country | US
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Telephone | 440-468-9239
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 57.010919
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License Number State | OH
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