Provider Demographics
NPI:1528548625
Name:WILKINSON, SHAE MARIE
Entity Type:Individual
Prefix:
First Name:SHAE
Middle Name:MARIE
Last Name:WILKINSON
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 1:3468 SOHO ST APT 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7514
Mailing Address - Country:US
Mailing Address - Phone:321-759-3083
Mailing Address - Fax:
Practice Address - Street 1:3468 SOHO ST APT 303
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7514
Practice Address - Country:US
Practice Address - Phone:321-759-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty