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General NPI Number Information
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NPI Number | 1205730579
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Entity Type | Individual
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Provider Name | SHAKORA JENNAY WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 445 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-3669
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Country | US
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Telephone | 516-280-1327
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Fax | 516-453-1339
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Provider Business Mailing Address
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Address Line | 938 ISLIP AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-8120
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Country | US
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Telephone | 929-944-9200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1492394
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License Number State | NY
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