MEDICARE: SHAUNTEL LATRYCE DAVIS PA-C

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	363A00000X	Physician Assistant	C0007328	MD

General Provider Information

NPI Number	:	1932675923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNTEL LATRYCE DAVIS PA-C

Provider Business Mailing Address
First Line	:	620 JOHN PAUL JONES CIR
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708-2111
Country	:	US
Telephone Number	:	800-465-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1885 TERRIER AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2203
Country	:	US
Telephone Number	:	757-953-9902
Fax Number	:	757-953-9908

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	07/15/2025

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