1194492918 NPI number — MRS. KEISHA ANN MONIQUE WILLIAMS PNP

Table of content: MRS. KEISHA ANN MONIQUE WILLIAMS PNP (NPI 1194492918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194492918 NPI number — MRS. KEISHA ANN MONIQUE WILLIAMS PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
KEISHA
Provider Middle Name:
ANN MONIQUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUARRIE
Provider Other First Name:
KEISHA
Provider Other Middle Name:
ANN MONIQUE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194492918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1543 STRAIGHT PATH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYANDANCH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11798-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-643-6006
Provider Business Mailing Address Fax Number:
631-643-7026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543 STRAIGHT PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYANDANCH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11798-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-643-6006
Provider Business Practice Location Address Fax Number:
631-643-7026
Provider Enumeration Date:
08/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  381475 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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