Provider Demographics
NPI:1427702083
Name:WILLIAMS, CHERYL (OWNER)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 SLOEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-2581
Mailing Address - Country:US
Mailing Address - Phone:352-787-0307
Mailing Address - Fax:352-787-0939
Practice Address - Street 1:306 AMANDA LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4652
Practice Address - Country:US
Practice Address - Phone:352-787-0307
Practice Address - Fax:352-787-0307
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690568496Medicaid