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Individual

DR. SHARISE WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
910 W END AVE, 1C, NEW YORK, NY 10025-3533
(212) 851-8100
(212) 932-0964
Mailing address
571 RICHMOND RD, EAST MEADOW, NY 11554-2231
(917) 434-5956

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
019779
NY
103T00000X
Psychologist
PS017156
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03548198
NY
Enumeration date
01/10/2012
Last updated
05/02/2013
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