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General NPI Number Information
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NPI Number | 1548917537
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Entity Type | Individual
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Provider Name | SHANNON PATRICIA WILLIAMS APRN
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 2330 N WICKHAM RD STE 12
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City | MELBOURNE
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State | FL
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Zip | 32935-8184
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Country | US
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Telephone | 321-633-3278
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 LOST LAKE CT
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City | SAINT CLOUD
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State | FL
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Zip | 34771-8814
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Country | US
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Telephone | 561-351-7057
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11018488
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License Number State | FL
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