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Individual

SHANI A WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPA-C

Contact information

Practice address
158 ORCHARD ST, ROCHESTER, NY 14611-1361
(585) 368-4500
(585) 436-6047
Mailing address
82 HOLLAND ST, ROCHESTER, NY 14605-2199
(585) 368-4500
(585) 436-6047

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
016834
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03743464
NY
Enumeration date
09/20/2013
Last updated
12/02/2020
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