MEDICARE: KRISTEN DAVIDSON, PSY.D., PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1316790942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN DAVIDSON, PSY.D., PLLC

Provider Business Mailing Address
First Line	:	13606 CASSIOPEIA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-9310
Country	:	US
Telephone Number	:	405-315-3070
Fax Number	:

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	:	CLINICAL NEUROPSYCHOLOGIST
Name	:	DR. KRISTEN MICHELLE DAVIDSON
Credential	:	PSYD
Telephone Number	:	407-793-1282

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	08/31/2025

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