Provider Demographics
NPI:1366077950
Name:WILLIAMS, MEGHAN
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
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 1:1118 S ORANGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1200
Mailing Address - Country:US
Mailing Address - Phone:407-896-9585
Mailing Address - Fax:
Practice Address - Street 1:1118 S ORANGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1200
Practice Address - Country:US
Practice Address - Phone:407-896-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2023-10-15
Deactivation Date:2023-08-29
Deactivation Code:
Reactivation Date:2023-09-27
Provider Licenses
StateLicense IDTaxonomies
OH20-111799106S00000X
FLAA843367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician