MEDICARE: ANNETASHA NICHOLE 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	2084P0800X	Psychiatry Physician	408236	NY

General Provider Information

NPI Number	:	1760338669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETASHA NICHOLE WILLIAMS

Provider Business Mailing Address
First Line	:	2724 SEYMOUR DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-6053
Country	:	US
Telephone Number	:	518-332-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 E 86TH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-2113
Country	:	US
Telephone Number	:	518-332-4948
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	04/13/2026

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