Healthcare Provider Details

I. General information

NPI: 1003326406
Provider Name (Legal Business Name): SHAMAR TYRE WILLIAMS NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 11/27/2023
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 THROGGS NECK EXPY
BRONX NY
10465-1717
US

IV. Provider business mailing address

548 THROGGS NECK EXPY
BRONX NY
10465-1717
US

V. Phone/Fax

Practice location:
  • Phone: 845-309-0037
  • Fax:
Mailing address:
  • Phone: 845-309-0037
  • Fax: 845-486-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number732032
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number732032
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: