MEDICARE: SNEHA WAGLE MBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	12772395-1205	UT

General Provider Information

NPI Number	:	1073174165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SNEHA WAGLE MBBS

Provider Business Mailing Address
First Line	:	15 N 2030 E RM 2110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5339
Country	:	US
Telephone Number	:	801-587-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 N 2030 E RM 2110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5339
Country	:	US
Telephone Number	:	801-587-9650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	03/09/2025

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