Healthcare Provider Details

I. General information

NPI: 1639758733
Provider Name (Legal Business Name): SHADONNA WILLIAMS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 ADDISON RD S
CAPITOL HEIGHTS MD
20743-4413
US

IV. Provider business mailing address

1442 ADDISON RD S
CAPITOL HEIGHTS MD
20743-4413
US

V. Phone/Fax

Practice location:
  • Phone: 304-888-2233
  • Fax: 301-997-1489
Mailing address:
  • Phone: 301-888-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024182531
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR200078
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: