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NPI Code Detail

MEDICARE: SHANDRA ANICIA DAVIS PSY.D.

MEDICARE: SHANDRA ANICIA DAVIS 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
1101YM0800XMental Health Counselor
2103T00000XPsychologist

General Provider Information

NPI Number : 1205190592
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANDRA ANICIA DAVIS PSY.D.
Provider Business Mailing Address
First Line : 10707 66TH ST N STE 7
Second Line :
City : PINELLAS PARK
State : FL
Zip : 33782-2336
Country : US
Telephone Number : 813-586-1529
Fax Number : 727-300-0221
Provider Business Practice Location Address
First Line : 10707 66TH ST N STE 7
Second Line :
City : PINELLAS PARK
State : FL
Zip : 33782-2336
Country : US
Telephone Number : 813-586-1529
Fax Number : 727-300-0221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 11/30/2022

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