Individual
SHANIQUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3627 UNIVERSITY BLVD S STE 705, JACKSONVILLE, FL 32216-7403
(904) 398-6718
(904) 396-0329
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
(904) 398-6718
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME162342
FL
Other
Enumeration date
03/23/2017
Last updated
06/19/2023
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