Provider Demographics
NPI:1487827143
Name:WILLIAMS, SHEREETA MELISSA (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHEREETA
Middle Name:MELISSA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHEREETA
Other - Middle Name:MELISSA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-3396
Mailing Address - Country:US
Mailing Address - Phone:631-940-8262
Mailing Address - Fax:631-940-8263
Practice Address - Street 1:1919 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3396
Practice Address - Country:US
Practice Address - Phone:631-940-8262
Practice Address - Fax:631-940-8263
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02017-1231H00000X
NY14000022341237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter