Provider Demographics
NPI:1730491119
Name:WILLIAMS, LE'SHAUN DENINE (LMT)
Entity Type:Individual
Prefix:
First Name:LE'SHAUN
Middle Name:DENINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 CHEVAL DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7073
Mailing Address - Country:US
Mailing Address - Phone:772-453-4450
Mailing Address - Fax:
Practice Address - Street 1:362 17TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0660
Practice Address - Country:US
Practice Address - Phone:772-453-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist