Provider Demographics
NPI:1881155372
Name:WILLIAMSON, SHATOYA
Entity type:Individual
Prefix:
First Name:SHATOYA
Middle Name:
Last Name:WILLIAMSON
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 1:3330 HARBOUR POINTE PL UNIT 7
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1764
Mailing Address - Country:US
Mailing Address - Phone:910-286-8431
Mailing Address - Fax:
Practice Address - Street 1:3330 HARBOUR POINTE PL UNIT 7
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1764
Practice Address - Country:US
Practice Address - Phone:910-286-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist