Wise, Shenelle-Marie Keisha
Wise, Shenelle-Marie Keisha is an individual health care provider with primary practice located at 2810 W Saint Isabel St Ste 201, Tampa FL 33607-6375. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Wise, Shenelle-Marie Keisha can be contacted via phone (813) 890-8004.Contact Information
Primary practice address
2810 W Saint Isabel St Ste 201
Tampa FL 33607-6375
Phone: (813) 890-8004
Fax: (813) 290-9691
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | ME124002 | Florida |
Profile Details
| NPI number | 1669739355 |
|---|---|
| LBN Legal business name | Wise, Shenelle-Marie Keisha |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 18th, 2012 |
| Last updated | Oct 28th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669739355 | NPPES |
| Florida | MEDICAID | 015568700 |
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