Provider Demographics
NPI:1497422331
Name:WILLIAMS, SHANIYA LATRICE (NP-C)
Entity Type:Individual
Prefix:
First Name:SHANIYA
Middle Name:LATRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CURRYCOMB DR APT C
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-2229
Mailing Address - Country:US
Mailing Address - Phone:803-989-0749
Mailing Address - Fax:
Practice Address - Street 1:2836 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3323
Practice Address - Country:US
Practice Address - Phone:803-939-0545
Practice Address - Fax:803-939-0583
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily