Provider Demographics
NPI:1427736941
Name:WILLIAMS, LASHUNDRA LATREICE
Entity type:Individual
Prefix:
First Name:LASHUNDRA
Middle Name:LATREICE
Last Name: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 1:2241 N MONROE ST # 1466
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4731
Mailing Address - Country:US
Mailing Address - Phone:800-484-1126
Mailing Address - Fax:
Practice Address - Street 1:464 FAMU WAY UNIT C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4251
Practice Address - Country:US
Practice Address - Phone:800-484-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X, 247ZC0005X, 246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician