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General NPI Number Information
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NPI Number | 1659173441
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Entity Type | Individual
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Provider Name | DALEYA SHIREE WILSON BACHELOR DEGREE
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Gender | Female
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 201 GAYLE POND TRCE
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City | COLUMBIA
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State | SC
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Zip | 29209-2734
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Country | US
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Telephone | 803-201-3584
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 WYNNEWOOD RD
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City | COLUMBIA
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State | SC
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Zip | 29223-3636
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Country | US
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Telephone | 803-201-3584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | 101629600
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License Number State | SC
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