Shontray Bernard Wilson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2770 Issued in AL

Practice address

619 19TH St S
Birmingham, AL 35249-1900

Phone

(205) 239-1623

NPI assigned

Jun 14, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1093601346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 19TH ST S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352491900",
            "telephone_number": "205-239-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 19TH ST S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352491900",
            "telephone_number": "205-239-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHONTRAY",
        "middle_name": "BERNARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-14",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "2770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peggy Calhoun Wilson, RPH
• Renda Wilson
• Sara Elizabeth Wilson, LICSW
• Sarah Cathryn Wilson
• Shanaium Wilson
• Stephanie Wilson
• Steven D. Wilson, ALC
• Susan Reese Wilson, LCSW
• Talia Wilson
• Tamara Wilson, MS, NBC-HWC

• Physician Assistant in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.