Provider Demographics
NPI:1003326406
Name:WILLIAMS, SHAMAR TYRE (NMD)
Entity Type:Individual
Prefix:DR
First Name:SHAMAR
Middle Name:TYRE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 THROGGS NECK EXPY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1717
Mailing Address - Country:US
Mailing Address - Phone:845-309-0037
Mailing Address - Fax:845-486-9801
Practice Address - Street 1:548 THROGGS NECK EXPY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1717
Practice Address - Country:US
Practice Address - Phone:845-309-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS732032175F00000X, 208D00000X, 208D00000X, 208D00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty