Provider Demographics
NPI:1134495724
Name:WILLIAMS, DOROTHEE ADJEHI (CNA)
Entity Type:Individual
Prefix:
First Name:DOROTHEE
Middle Name:ADJEHI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:DOROTHEE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 1576
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-0439
Mailing Address - Country:US
Mailing Address - Phone:631-575-6024
Mailing Address - Fax:
Practice Address - Street 1:127 WHEATLEY RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1210
Practice Address - Country:US
Practice Address - Phone:631-575-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340656640995E390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program