Healthcare Provider Details

I. General information

NPI: 1487268173
Provider Name (Legal Business Name): SONDRA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 PROVIDENCE HWY UNIT 25
NORWOOD MA
02062-4647
US

IV. Provider business mailing address

278R PRINCETON ST
EAST BOSTON MA
02128-1435
US

V. Phone/Fax

Practice location:
  • Phone: 617-401-7700
  • Fax:
Mailing address:
  • Phone: 413-822-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2330262
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2330262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: