Provider Demographics
NPI:1801393830
Name:WILLIAMS, SHAWN MARIE (C PED)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CLINTON AVE S STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5621
Mailing Address - Country:US
Mailing Address - Phone:585-442-4990
Mailing Address - Fax:
Practice Address - Street 1:1900 CLINTON AVE S STE 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5621
Practice Address - Country:US
Practice Address - Phone:585-442-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist