Healthcare Provider Details

I. General information

NPI: 1205665841
Provider Name (Legal Business Name): WISE SHAHID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HIGH GLEN DR APT F
CHARLOTTE NC
28269-9741
US

IV. Provider business mailing address

3000 HIGH GLEN DR APT F
CHARLOTTE NC
28269-9741
US

V. Phone/Fax

Practice location:
  • Phone: 804-610-5522
  • Fax:
Mailing address:
  • Phone: 248-256-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: