MEDICARE: DR. KRISTEN DAVIDSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY11597	FL

General Provider Information

NPI Number	:	1043573454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN DAVIDSON PSY.D.

Provider Business Mailing Address
First Line	:	3801 AVALON PARK EAST BLVD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4902
Country	:	US
Telephone Number	:	407-793-1282
Fax Number	:	833-895-1282

Provider Business Practice Location Address
First Line	:	3801 AVALON PARK EAST BLVD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4902
Country	:	US
Telephone Number	:	407-793-1282
Fax Number	:	833-895-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	08/31/2025

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