Provider Demographics
NPI:1104099399
Name:WILLIAMS-MCNEALY, SHYNEQURIA DONSHEA
Entity type:Individual
Prefix:
First Name:SHYNEQURIA
Middle Name:DONSHEA
Last Name:WILLIAMS-MCNEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:FL
Mailing Address - Zip Code:32332-0250
Mailing Address - Country:US
Mailing Address - Phone:850-875-3350
Mailing Address - Fax:
Practice Address - Street 1:2457 CARE DR
Practice Address - Street 2:SUITE D100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3501
Practice Address - Country:US
Practice Address - Phone:850-841-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9167823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily