Provider Demographics
NPI:1285096875
Name:MCFADDEN, SHARI (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:SHARI
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6333
Mailing Address - Country:US
Mailing Address - Phone:414-464-6610
Mailing Address - Fax:
Practice Address - Street 1:1935 W SILVER SPRING DR
Practice Address - Street 2:UNIT 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-4445
Practice Address - Country:US
Practice Address - Phone:414-464-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI95989-821744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI811932834OtherTAX ID