Provider Demographics
NPI:1720410301
Name:WILLIAMS, PAULETTE LELEITH (SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:LELEITH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11603 225TH ST
Mailing Address - Street 2:CAMBRIA HEIGHTS
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1710
Mailing Address - Country:US
Mailing Address - Phone:917-399-4054
Mailing Address - Fax:718-528-1467
Practice Address - Street 1:11603 225TH ST
Practice Address - Street 2:CAMBRIA HEIGHTS
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1710
Practice Address - Country:US
Practice Address - Phone:917-399-4054
Practice Address - Fax:718-528-1467
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist