Healthcare Provider Details

I. General information

NPI: 1902790892
Provider Name (Legal Business Name): MRS. AFFTIN L DAVIS HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AFFTIN L DAVIS

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 KNIGHT ST
NORWALK CT
06851-4725
US

IV. Provider business mailing address

200 BRYANT AVE
ELMSFORD NY
10523-2118
US

V. Phone/Fax

Practice location:
  • Phone: 914-882-4141
  • Fax:
Mailing address:
  • Phone: 914-882-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number001179
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: