Provider Demographics
NPI:1245917301
Name:WILSON, BRITTANY SHAMIYAH
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SHAMIYAH
Last Name: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 1:12803 REXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-2673
Mailing Address - Country:US
Mailing Address - Phone:440-212-5967
Mailing Address - Fax:
Practice Address - Street 1:12803 REXFORD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-2673
Practice Address - Country:US
Practice Address - Phone:440-212-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant