Provider Demographics
NPI:1477304525
Name:WILLIAMS, SHARON SUSAN (CERTIFIED)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 NEW ENGLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5350
Mailing Address - Country:US
Mailing Address - Phone:203-543-7012
Mailing Address - Fax:
Practice Address - Street 1:329 NEW ENGLAND AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5350
Practice Address - Country:US
Practice Address - Phone:203-543-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCERTIFIED171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach