Active NPI
Shavona Wilson, LSW
- Social Worker
- Philadelphia, PA
National Provider Identifier
1457030603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- SW139889
- Practice address
- 9168 Ellie Dr # B
Philadelphia, PA 19114-2857 - Phone
- (856) 412-1769
- NPI assigned
- Jul 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | SW139889 | PA | Primary |
Addresses
Primary practice location
9168 Ellie Dr # B
Philadelphia, PA 19114-2857
Mailing address
9168 Ellie Dr # B
Philadelphia, PA 19114-2857
Phone (856) 412-1769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW139889 | PA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689292800000",
"number": "1457030603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9168 ELLIE DR # B",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191142857",
"telephone_number": "856-412-1769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9168 ELLIE DR # B",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191142857",
"telephone_number": "856-412-1769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHAVONA",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-14",
"last_updated": "2023-07-14",
"certification_date": "2023-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "PA",
"license": "SW139889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.