Individual
SHANISSE WYMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1405 S BROAD ST, WINSTON SALEM, NC 27127-2068
(347) 872-8853
Mailing address
27777 INKSTER RD STE 100, FARMINGTON HILLS, MI 48334-5312
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-78475
NC
Other
Enumeration date
01/20/2020
Last updated
02/20/2025
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