Provider Demographics
NPI:1992030654
Name:WILSON, SUNSHINE (MA)
Entity Type:Individual
Prefix:
First Name:SUNSHINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 G ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3114
Mailing Address - Country:US
Mailing Address - Phone:619-452-5064
Mailing Address - Fax:
Practice Address - Street 1:1570 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8502
Practice Address - Country:US
Practice Address - Phone:714-834-1111
Practice Address - Fax:714-972-0454
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60110325235Z00000X
CASP 20726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist