Provider Demographics
NPI:1467003400
Name:WILLIAMS, SHAYNA NICOLE
Entity Type:Individual
Prefix:MS
First Name:SHAYNA
Middle Name:NICOLE
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 1:1803 ARCHER ST APT 19
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-6200
Mailing Address - Country:US
Mailing Address - Phone:917-331-4292
Mailing Address - Fax:
Practice Address - Street 1:4302 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1831
Practice Address - Country:US
Practice Address - Phone:718-686-9600
Practice Address - Fax:718-686-6161
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist