Healthcare Provider Details

I. General information

NPI: 1164964987
Provider Name (Legal Business Name): SHAREECE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11119 200TH ST
SAINT ALBANS NY
11412-2137
US

IV. Provider business mailing address

11119 200TH ST
SAINT ALBANS NY
11412-2137
US

V. Phone/Fax

Practice location:
  • Phone: 917-474-6476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number103K00000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: