Provider Demographics
NPI:1598803991
Name:WILLIAMS, SHELLEY LYNNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2103 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2002
Mailing Address - Country:US
Mailing Address - Phone:301-439-0267
Mailing Address - Fax:301-589-8917
Practice Address - Street 1:8240 GEORGIA AVE
Practice Address - Street 2:102
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4511
Practice Address - Country:US
Practice Address - Phone:301-589-9333
Practice Address - Fax:301-589-8917
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152031800Medicaid
MDF65407Medicare UPIN