Individual
DR. SHARISE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
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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