Healthcare Provider Details

I. General information

NPI: 1265471676
Provider Name (Legal Business Name): VICTORIA EDMOND-DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA J EDMOND DAVIS MD

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

2722 MERRILEE DR STE 230
FAIRFAX VA
22031-4400
US

V. Phone/Fax

Practice location:
  • Phone: 904-236-5884
  • Fax:
Mailing address:
  • Phone: 703-698-4483
  • Fax: 703-573-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.147530
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0087992
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101240073
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME162702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: