Shawanda Rene Wilder

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

2489 Diplomat Pkwy E
Cape Coral, FL 33909-5422

Phone

(239) 652-1800

Fax

(239) 652-1932

NPI assigned

Oct 2, 2020

Last updated

Oct 2, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1174120265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 N 10TH ST",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422908",
            "telephone_number": "239-290-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2489 DIPLOMAT PKWY E",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339095422",
            "telephone_number": "239-652-1800",
            "fax_number": "239-652-1932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "SHAWANDA",
        "middle_name": "RENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VETERAN AFFAIRS",
            "identifier": "W436-796-90--922-1",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeromy Whyte
• Malgorzata Wieczorek, PHARMD
• Alyssa Wiedeman, RDN
• Stanley L Wiggins, M.D.
• Allison Wight, PA-C
• Scott E Wiley, M.D.
• Petra P Wilkes, MFT, MHC
• Maria Carla Williams Miari
• Apache Williams
• Brandy Williams

• Clinical Social Worker in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.