MEDICARE: SHACRISA LASHAE WILSON

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
1	374U00000X	Home Health Aide		SC

General Provider Information

NPI Number	:	1811820749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHACRISA LASHAE WILSON

Provider Business Mailing Address
First Line	:	116 SAINT CHARLES WAY
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-3660
Country	:	US
Telephone Number	:	843-834-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 RIVERS AVE STE 182
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4650
Country	:	US
Telephone Number	:	843-834-4932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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