Healthcare Provider Details

I. General information

NPI: 1366026783
Provider Name (Legal Business Name): MELISSA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13212 133RD AVE
SOUTH OZONE PARK NY
11420-3813
US

IV. Provider business mailing address

132-12 133 AVENUE
JAMAICA NY
11420
US

V. Phone/Fax

Practice location:
  • Phone: 516-451-3341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: