Organization
SHAUNA WILLIAMSON SOLE MBR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNA WILLIAMSON (PROVIDER)
(347) 274-5753
Entity
Organization
Contact information
Practice address
673 E 137TH ST APT 6A, BRONX, NY 10454-3332
(347) 274-5753
Mailing address
673 E 137TH ST APT 6A, BRONX, NY 10454-3332
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
815820126
—
NY
Enumeration date
12/23/2020
Last updated
12/23/2020
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