Provider Demographics
NPI:1548917537
Name:WILLIAMS, SHANNON PATRICIA (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:PATRICIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LOST LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8814
Mailing Address - Country:US
Mailing Address - Phone:561-351-7057
Mailing Address - Fax:
Practice Address - Street 1:2330 N WICKHAM RD STE 12
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8184
Practice Address - Country:US
Practice Address - Phone:321-633-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine