Provider Demographics
NPI:1619659075
Name:WRIGHT-WILSON, SHENIQUE
Entity Type:Individual
Prefix:
First Name:SHENIQUE
Middle Name:
Last Name:WRIGHT-WILSON
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 1:8773 EVANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7115
Mailing Address - Country:US
Mailing Address - Phone:843-605-5034
Mailing Address - Fax:
Practice Address - Street 1:8773 EVANGELINE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7115
Practice Address - Country:US
Practice Address - Phone:843-605-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider