MEDICARE: MRS. KEISHA ANN MONIQUE WILLIAMS PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	381475	NY

General Provider Information

NPI Number	:	1194492918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEISHA ANN MONIQUE WILLIAMS PNP

Provider Business Mailing Address
First Line	:	1543 STRAIGHT PATH
Second Line	:
City	:	WYANDANCH
State	:	NY
Zip	:	11798-3415
Country	:	US
Telephone Number	:	631-643-6006
Fax Number	:	631-643-7026

Provider Business Practice Location Address
First Line	:	1543 STRAIGHT PATH
Second Line	:
City	:	WYANDANCH
State	:	NY
Zip	:	11798-3415
Country	:	US
Telephone Number	:	631-643-6006
Fax Number	:	631-643-7026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2021
Last Update Date	:	06/23/2025

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