Provider Demographics
NPI:1326786765
Name:WILSON, SHAMEKA DAYSHAN (PMHNP)
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:DAYSHAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5350 TOMAH DR STE 3600
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6991
Mailing Address - Country:US
Mailing Address - Phone:970-806-4972
Mailing Address - Fax:888-965-4615
Practice Address - Street 1:5350 TOMAH DR STE 3600
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6991
Practice Address - Country:US
Practice Address - Phone:970-806-4972
Practice Address - Fax:888-965-4615
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2020131915363LP0808X
COC-APN.0102397-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health