Provider Demographics
NPI:1619224680
Name:WILLIAMS-CREDLE, SHA-WONDA ROBIN
Entity Type:Individual
Prefix:
First Name:SHA-WONDA
Middle Name:ROBIN
Last Name:WILLIAMS-CREDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25837A FRANCIS LEWIS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25837A FRANCIS LEWIS BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3305
Practice Address - Country:US
Practice Address - Phone:917-544-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist