Provider Demographics
NPI:1073393682
Name:WILLIAMS, SHAUNTAVIA (CRANIAL PROSTHETIC)
Entity Type:Individual
Prefix:MS
First Name:SHAUNTAVIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRANIAL PROSTHETIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 GALLERIA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6715
Mailing Address - Country:US
Mailing Address - Phone:972-816-3050
Mailing Address - Fax:
Practice Address - Street 1:2813 GALLERIA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6715
Practice Address - Country:US
Practice Address - Phone:972-816-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1631040224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist