Healthcare Provider Details

I. General information

NPI: 1730286527
Provider Name (Legal Business Name): VASHAUN OMAR WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

1936 BRUCE B DOWNS BLVD # 318
WESLEY CHAPEL FL
33544-9262
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax: 877-538-2102
Mailing address:
  • Phone: 813-381-5525
  • Fax: 813-381-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 94842
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24930
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 94842
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number24930
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: