Provider Demographics
NPI:1497121925
Name:WILKER, ENAS SHAKKOUR (RD)
Entity Type:Individual
Prefix:
First Name:ENAS
Middle Name:SHAKKOUR
Last Name:WILKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ENAS
Other - Middle Name:
Other - Last Name:SHAKKOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 LEES COURT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1315 MATTHEWS MINT HILL RD STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2694
Practice Address - Country:US
Practice Address - Phone:704-846-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC882133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered