Healthcare Provider Details

I. General information

NPI: 1073398913
Provider Name (Legal Business Name): SHAYLA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WELLNESS DR
SUMMERSVILLE WV
26651-5401
US

IV. Provider business mailing address

180 WELLNESS DR
SUMMERSVILLE WV
26651-5401
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-0058
  • Fax: 304-872-1006
Mailing address:
  • Phone: 48-720-0583
  • Fax: 304-872-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: