Shaunda Lyn Waddle, CSFA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

5001 Opal Dr
Cheyenne, WY 82009-5693

Phone

(307) 214-6537

NPI assigned

Dec 13, 2021

Last updated

Jan 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Miss Shaunda Lyn Lamphere Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1366101784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 OPAL DR",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820095693",
            "telephone_number": "307-214-6537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 OPAL DR",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820095693",
            "telephone_number": "307-214-6537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDLE",
        "first_name": "SHAUNDA",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "CSFA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-13",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "WY",
            "license": "206758",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAUNDA",
            "last_name": "LAMPHERE",
            "middle_name": "LYN",
            "prefix": "MISS",
            "credential": "CSFA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole M Vorderberg, RN
• Colby Vossler, PA-C
• Kristin Voycheske
• Corrine Vrijhof, BA
• Korbe Christopher Wadas
• Ron W Waeckerlin, M.D.
• Anne S Wagner, LCSW
• Kelsey Leigh Wagner, PA
• Philip L Wagner, MD
• Megan M Wagnon, PHARMACIST

• Surgical Physician Assistant in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Surgical Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.