Provider Demographics
NPI:1194161240
Name:WILLIAMD, SIMONE
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:WILLIAMD
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 1:2511 LUTHER RD
Mailing Address - Street 2:APT 417
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-2646
Mailing Address - Country:US
Mailing Address - Phone:954-393-2758
Mailing Address - Fax:
Practice Address - Street 1:2511 LUTHER RD
Practice Address - Street 2:APT 417
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-2646
Practice Address - Country:US
Practice Address - Phone:954-393-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker