Individual
SIJIE JOY SHEN-WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
877 W FARIS RD STE A, GREENVILLE, SC 29605-4296
(864) 455-7800
(803) 434-7231
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6174
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38737
SC
207Q00000X
Family Medicine Physician
ME116152
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009096500
—
FL
01
—
14R6S
BCBSFL
FL
05
—
387370
—
SC
Enumeration date
06/11/2010
Last updated
09/13/2018
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