MEDICARE: SHATONYA DAVIS

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	363LF0000X	Family Nurse Practitioner	11006726	FL

General Provider Information

NPI Number	:	1417585589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATONYA DAVIS

Provider Business Mailing Address
First Line	:	3040 NW 187TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3015
Country	:	US
Telephone Number	:	305-878-7881
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 NW 187TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3015
Country	:	US
Telephone Number	:	305-878-7881
Fax Number	:

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	05/11/2020

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