Individual
MRS. SHAUNDA LYN WADDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
5001 OPAL DR, CHEYENNE, WY 82009-5693
(307) 214-6537
Mailing address
5001 OPAL DR, CHEYENNE, WY 82009-5693
(307) 214-6537
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
206758
WY
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
12/13/2021
Last updated
01/06/2022
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