Healthcare Provider Details

I. General information

NPI: 1942056528
Provider Name (Legal Business Name): SHANTEE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 W BEACON RD
LAKELAND FL
33803-2847
US

IV. Provider business mailing address

4937 US HIGHWAY 98 N STE 812
LAKELAND FL
33809-3610
US

V. Phone/Fax

Practice location:
  • Phone: 863-220-1205
  • Fax: 863-250-1812
Mailing address:
  • Phone: 863-220-1205
  • Fax: 863-250-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: