Provider Demographics
NPI:1730549189
Name:WILSON, SHAREN CARIZO (DO)
Entity type:Individual
Prefix:MRS
First Name:SHAREN
Middle Name:CARIZO
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHAREN
Other - Middle Name:CARIZO
Other - Last Name:KEMP-DUKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11114 HILLSDALE DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1903
Mailing Address - Country:US
Mailing Address - Phone:240-566-6316
Mailing Address - Fax:
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-2722
Practice Address - Country:US
Practice Address - Phone:301-295-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-28
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program