MEDICARE: WENDY WILLIAMS

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	252Y00000X	Early Intervention Provider Agency	889938	NY

General Provider Information

NPI Number	:	1235674599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY WILLIAMS

Provider Business Mailing Address
First Line	:	5145 NORTH BLOOMFILED ROAD
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424
Country	:	US
Telephone Number	:	585-394-1190
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 NORTH BLOOMFILED ROAD
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424
Country	:	US
Telephone Number	:	585-394-1190
Fax Number	:

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

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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