Healthcare Provider Details

I. General information

NPI: 1689598427
Provider Name (Legal Business Name): SHANA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 FORT LINCOLN DR NE APT 725
WASHINGTON DC
20018-4328
US

IV. Provider business mailing address

2345 GREEN ST SE APT 4
WASHINGTON DC
20020-7327
US

V. Phone/Fax

Practice location:
  • Phone: 202-280-8707
  • Fax:
Mailing address:
  • Phone: 202-378-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: