Provider Demographics
NPI:1023285509
Name:WILLIAMS, SHADRIENNE NIKEIA
Entity type:Individual
Prefix:MRS
First Name:SHADRIENNE
Middle Name:NIKEIA
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 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:748 S NEW ST
Practice Address - Street 2:SUITES C & D
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3573
Practice Address - Country:US
Practice Address - Phone:302-734-3227
Practice Address - Fax:303-734-0391
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1023285509Medicaid
DE286809ZBZRMedicare PIN