Provider Demographics
NPI:1184793135
Name:WILLIAMS, AGATHA P
Entity type:Individual
Prefix:MS
First Name:AGATHA
Middle Name:P
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:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-0056
Mailing Address - Country:US
Mailing Address - Phone:516-640-5982
Mailing Address - Fax:
Practice Address - Street 1:95 GRASSLANDS RD NICU 2ND FLOOR
Practice Address - Street 2:MARIA FARERI CHILDRENS HOSPITAL AT WMS
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381495363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics