Healthcare Provider Details

I. General information

NPI: 1972304160
Provider Name (Legal Business Name): SHAVON A DAVIS RN MSN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAVON A CRAWFORD

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

8015 PLYMOUTH ST
OAKLAND CA
94621-2327
US

V. Phone/Fax

Practice location:
  • Phone: 510-214-4444
  • Fax:
Mailing address:
  • Phone: 510-214-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number317422
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number95229454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: