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NPI Code Detail

MEDICARE: SHAWN WILSON PHD

MEDICARE: SHAWN WILSON PHD
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
1174H00000XHealth Educator

General Provider Information

NPI Number : 1063201754
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN WILSON PHD
Provider Business Mailing Address
First Line : 98 S LOS ROBLES AVE
Second Line :
City : PASADENA
State : CA
Zip : 91101-2433
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 98 S LOS ROBLES AVE
Second Line :
City : PASADENA
State : CA
Zip : 91101-2433
Country : US
Telephone Number : 626-848-4152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2025
Last Update Date : 05/01/2025

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