Provider Demographics
NPI:1407346497
Name:ALLEN-WILLIAMS, CARMEYA
Entity type:Individual
Prefix:
First Name:CARMEYA
Middle Name:
Last Name:ALLEN-WILLIAMS
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 1:650 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2319
Mailing Address - Country:US
Mailing Address - Phone:315-426-7680
Mailing Address - Fax:315-426-7798
Practice Address - Street 1:1017 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3915
Practice Address - Country:US
Practice Address - Phone:315-428-0320
Practice Address - Fax:315-426-7798
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246518164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407346497Medicaid
NY246518OtherLICENCE PRACTICAL NURSE