Healthcare Provider Details

I. General information

NPI: 1629989884
Provider Name (Legal Business Name): JURNEE SHI'AYR BROOKS-WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N DUPONT HWY
DOVER DE
19901-2202
US

IV. Provider business mailing address

112 WASHINGTON RD
CENTREVILLE MD
21617-2337
US

V. Phone/Fax

Practice location:
  • Phone: 302-857-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: