Individual
MISS DALEYA SHIREE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BACHELOR DEGREE
Contact information
Practice address
201 GAYLE POND TRCE, COLUMBIA, SC 29209-2734
(803) 201-3584
Mailing address
1606 WYNNEWOOD RD, COLUMBIA, SC 29223-3636
(803) 201-3584
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
101629600
SC
Other
Enumeration date
03/25/2025
Last updated
03/25/2025
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