Healthcare Provider Details

I. General information

NPI: 1710823596
Provider Name (Legal Business Name): SANIYAH KELIS DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10817 BLOOMINGDALE AVE FL 33578
RIVERVIEW FL
33578-3616
US

IV. Provider business mailing address

9225 BAY PLAZA BLVD
TAMPA FL
33619-4466
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-3529
  • Fax:
Mailing address:
  • Phone: 813-814-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: