Basic Information
Provider Information
NPI: 1144979733
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: WHITNEY
MiddleName: SADE
NamePrefix:  
NameSuffix:  
Credential: RBT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7555 CLAXSTRAUSS DR
Address2:  
City: SARASOTA
State: FL
PostalCode: 342409699
CountryCode: US
TelephoneNumber: 9418670816
FaxNumber: 3523142909
Practice Location
Address1: 7555 CLAXSTRAUSS DR
Address2:  
City: SARASOTA
State: FL
PostalCode: 342409699
CountryCode: US
TelephoneNumber: 9418670816
FaxNumber: 3523142909
Other Information
ProviderEnumerationDate: 03/21/2022
LastUpdateDate: 03/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-22-203168FLY193400000X SINGLE SPECIALTY GROUP   

No ID Information.


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