Healthcare Provider Details

I. General information

NPI: 1669175881
Provider Name (Legal Business Name): SHAKELA RENEE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 6TH ST NW
WINTER HAVEN FL
33881-2368
US

IV. Provider business mailing address

1540 6TH ST NW
WINTER HAVEN FL
33881-2368
US

V. Phone/Fax

Practice location:
  • Phone: 904-401-5076
  • Fax:
Mailing address:
  • Phone: 904-401-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME183378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: