Individual
CARMEN SHAW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
330 BROOKLINE AVENUE, SHAPIRO BUILDING, GROUND FLOOR, SUITE SCG63, BOSTON, MA 02215
(617) 632-7500
Mailing address
330 BROOKLINE AVE BLDG GROUP, SHAPIRO BUILDING, GROUND FLOOR, SUITE SCG63, BOSTON, MA 02215-5491
(617) 632-7500
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
4731
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110171698A
—
MA
Enumeration date
07/18/2018
Last updated
07/22/2022
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