Provider Demographics
NPI:1699068445
Name:WILSON, SHAWN ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ANTHONY
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5838 HARBOUR VIEW BLVD BLDG STE 100
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2663
Mailing Address - Country:US
Mailing Address - Phone:757-673-5680
Mailing Address - Fax:757-483-3075
Practice Address - Street 1:5838 HARBOUR VIEW BLVD BLDG STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:757-673-5680
Practice Address - Fax:757-483-3075
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102205257207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery