Provider Demographics
NPI:1003170929
Name:WILLIAMS, CHERYL ELAINE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1835
Mailing Address - Country:US
Mailing Address - Phone:443-566-0655
Mailing Address - Fax:
Practice Address - Street 1:900 E PULASKI HWY FL 2
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6304
Practice Address - Country:US
Practice Address - Phone:443-566-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist