Individual
SHARON EMANVELA WONDRACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 PATEWOOD DR, SUITE B460, GREENVILLE, SC 29615-3593
(864) 454-2226
(864) 454-2223
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28065
SC
208000000X
Pediatrics Physician
28065
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280653
—
SC
01
—
P00786467
RR MEDICARE
SC
Enumeration date
09/25/2006
Last updated
06/24/2021
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