Healthcare Provider Details

I. General information

NPI: 1851440457
Provider Name (Legal Business Name): SHEILA M DAVIS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST COX 5
BOSTON MA
02114-2621
US

IV. Provider business mailing address

173 DAVIS AVE APT 8
BROOKLINE MA
02445-6026
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3906
  • Fax: 617-726-7653
Mailing address:
  • Phone: 617-731-7751
  • Fax: 617-726-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number186293
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: