Provider Demographics
NPI:1831445444
Name:WILSON, DEBRA PATRICIA (MSED)
Entity type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:PATRICIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 UNIVERSE DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4234
Mailing Address - Country:US
Mailing Address - Phone:516-589-3534
Mailing Address - Fax:
Practice Address - Street 1:68 UNIVERSE DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4234
Practice Address - Country:US
Practice Address - Phone:516-589-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1935781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist