Provider Demographics
NPI:1760900856
Name:WILLIAMS, SHYANNE KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHYANNE
Middle Name:KATHERINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:GINTER
Mailing Address - State:PA
Mailing Address - Zip Code:16651-9557
Mailing Address - Country:US
Mailing Address - Phone:814-553-0724
Mailing Address - Fax:
Practice Address - Street 1:34 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1927
Practice Address - Country:US
Practice Address - Phone:570-645-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine