MEDICARE: SHAMICA N WILLIAMS CNA

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	364SH0200X	Home Health Clinical Nurse Specialist	CNA267173	FL

General Provider Information

NPI Number	:	1568042646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMICA N WILLIAMS CNA

Provider Business Mailing Address
First Line	:	503 JEAN ST APT 3
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4673
Country	:	US
Telephone Number	:	386-675-3365
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 JEAN ST APT 3
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4673
Country	:	US
Telephone Number	:	386-675-3365
Fax Number	:

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

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/12/2021

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