Provider Demographics
NPI:1992698781
Name:CHANG-WILLIAMS MEDICAL, LLC
Entity type:Organization
Organization Name:CHANG-WILLIAMS MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:813-334-6134
Mailing Address - Street 1:12191 W LINEBAUGH AVE STE 607
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1732
Mailing Address - Country:US
Mailing Address - Phone:813-334-6134
Mailing Address - Fax:
Practice Address - Street 1:7927 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6783
Practice Address - Country:US
Practice Address - Phone:727-863-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility