Provider Demographics
NPI:1518641984
Name:WYLIE, SHILETHA JANISE
Entity Type:Individual
Prefix:
First Name:SHILETHA
Middle Name:JANISE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8428 FOUR SISTERS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8904
Mailing Address - Country:US
Mailing Address - Phone:704-724-4667
Mailing Address - Fax:
Practice Address - Street 1:8428 FOUR SISTERS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8904
Practice Address - Country:US
Practice Address - Phone:704-724-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other