Provider Demographics
NPI:1255776753
Name:WILSON, JOYCELYN
Entity type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:
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 1:1475 GENEVA LOOP
Mailing Address - Street 2:APT. 8E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2421
Mailing Address - Country:US
Mailing Address - Phone:347-405-8682
Mailing Address - Fax:
Practice Address - Street 1:1475 GENEVA LOOP
Practice Address - Street 2:APT. 8E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2421
Practice Address - Country:US
Practice Address - Phone:347-405-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY885022174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator