Provider Demographics
NPI:1942887666
Name:WILLIAMS, SHANA DANIELLE
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:DANIELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:DANIELLE
Other - Last Name:STRUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-8948
Mailing Address - Country:US
Mailing Address - Phone:440-647-2225
Mailing Address - Fax:440-647-5110
Practice Address - Street 1:840 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-8948
Practice Address - Country:US
Practice Address - Phone:440-647-2225
Practice Address - Fax:440-647-5110
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.149849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program