Provider Demographics
NPI:1922193499
Name:WILLIAMS, SHANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WEST OAKLAND PARK BLVD.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311
Mailing Address - Country:US
Mailing Address - Phone:954-731-7200
Mailing Address - Fax:954-485-6336
Practice Address - Street 1:2800 WEST OAKLAND PARK BLVD.
Practice Address - Street 2:SUITE 306
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311
Practice Address - Country:US
Practice Address - Phone:954-731-7200
Practice Address - Fax:954-485-6336
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3111Medicare ID - Type Unspecified