Provider Demographics
NPI:1740828821
Name:WILLIAMS, SHAWN BYNUM
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:BYNUM
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 1:5601 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2002
Mailing Address - Country:US
Mailing Address - Phone:757-236-1433
Mailing Address - Fax:
Practice Address - Street 1:5601 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2002
Practice Address - Country:US
Practice Address - Phone:757-236-1433
Practice Address - Fax:757-245-2715
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle