MEDICARE: SONCERAY DAVIS CMA, CNA, GNA,

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	376K00000X	Nurse's Aide	A00111350	MD

General Provider Information

NPI Number	:	1588395990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONCERAY DAVIS CMA, CNA, GNA,

Provider Business Mailing Address
First Line	:	1325 BEDFORD AVE UNIT 32247
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21282-7542
Country	:	US
Telephone Number	:	443-722-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 PARK HEIGHTS AVE
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-5407
Country	:	US
Telephone Number	:	443-722-0844
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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