Provider Demographics
NPI:1689169021
Name:WILLIAMS, SHERYL ANTOINETE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:ANTOINETE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:MS
Other - First Name:SHERYL
Other - Middle Name:ANTOINETE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:176 STATE ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3516
Mailing Address - Country:US
Mailing Address - Phone:201-403-7417
Mailing Address - Fax:
Practice Address - Street 1:176 STATE ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3516
Practice Address - Country:US
Practice Address - Phone:201-403-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
NJ32WD03414200247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management