Provider Demographics
NPI:1508530809
Name:WILLIAMS, CHARDAY SHANICE (CNA, CNA II)
Entity Type:Individual
Prefix:
First Name:CHARDAY
Middle Name:SHANICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA, CNA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 IRON MEADOW RUN APT 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-2446
Mailing Address - Country:US
Mailing Address - Phone:919-288-4212
Mailing Address - Fax:
Practice Address - Street 1:610 IRON MEADOW RUN APT 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-2446
Practice Address - Country:US
Practice Address - Phone:919-288-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC440202376K00000X
NC78355376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC951514382TMedicaid