Provider Demographics
NPI:1881948883
Name:WILLIAMS, TANYA L (MS, CSSD, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, CSSD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 MORGAN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-8569
Mailing Address - Country:US
Mailing Address - Phone:570-772-0757
Mailing Address - Fax:
Practice Address - Street 1:460 NORTH MARKET STREET SUITE 212
Practice Address - Street 2:THE WILLIAMSPORT BUILDING
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3851
Practice Address - Country:US
Practice Address - Phone:570-745-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered