Healthcare Provider Details

I. General information

NPI: 1235855099
Provider Name (Legal Business Name): SHIMIRA T WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 JACKSON ST
LAKE HELEN FL
32744-2213
US

IV. Provider business mailing address

PO BOX 3465
DELAND FL
32721-3465
US

V. Phone/Fax

Practice location:
  • Phone: 386-215-2071
  • Fax:
Mailing address:
  • Phone: 386-215-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: