MEDICARE: SALENA WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	401846720416	OH

General Provider Information

NPI Number	:	1629817259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALENA WILSON

Provider Business Mailing Address
First Line	:	1224 SHARONBROOK DR
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2754
Country	:	US
Telephone Number	:	216-387-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	3691 LEE RD STE 105
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-5139
Country	:	US
Telephone Number	:	216-387-6896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/12/2026

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Directions to “ SALENA WILSON ” Practice Location

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