MEDICARE: CHERIELYNN S WAGNER DO

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	207Q00000X	Family Medicine Physician	04802	IA
2	207Q00000X	Family Medicine Physician	DO3788	NV

General Provider Information

NPI Number	:	1295175271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIELYNN S WAGNER DO

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4919 W CRAIG RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2730
Country	:	US
Telephone Number	:	725-220-8706
Fax Number	:	833-749-0366

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

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	03/05/2026

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Directions to “ CHERIELYNN S WAGNER DO” Practice Location

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