Provider Demographics
NPI:1386991388
Name:WILLIAMS, ANNYE (DOM)
Entity type:Individual
Prefix:
First Name:ANNYE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:ANNYE
Other - Middle Name:
Other - Last Name:AVANT-PYBAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 SARNO RD
Mailing Address - Street 2:207
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4938
Mailing Address - Country:US
Mailing Address - Phone:321-549-8447
Mailing Address - Fax:
Practice Address - Street 1:1600 SARNO RD
Practice Address - Street 2:207
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4938
Practice Address - Country:US
Practice Address - Phone:321-549-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2905171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist