MEDICARE: LA SHANEE RENEE DAVIS MSED, THD

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	103K00000X	Behavior Analyst		NJ

General Provider Information

NPI Number	:	1255142345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA SHANEE RENEE DAVIS MSED, THD

Provider Business Mailing Address
First Line	:	264 MIDLAND AVE UNIT 28
Second Line	:
City	:	SADDLE BROOK
State	:	NJ
Zip	:	07663-6415
Country	:	US
Telephone Number	:	917-659-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 MIDLAND AVE UNIT 28
Second Line	:
City	:	SADDLE BROOK
State	:	NJ
Zip	:	07663-6415
Country	:	US
Telephone Number	:	917-659-9244
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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