Provider Demographics
NPI:1821247099
Name:WILLIAMS, SHARON DENISE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36607 MENOMINEE LN
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-7963
Mailing Address - Country:US
Mailing Address - Phone:352-321-0294
Mailing Address - Fax:
Practice Address - Street 1:36607 MENOMINEE LN
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-7963
Practice Address - Country:US
Practice Address - Phone:352-321-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL693041796172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693041796Medicaid