Healthcare Provider Details

I. General information

NPI: 1437065042
Provider Name (Legal Business Name): AMANDA NICOLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 ASTORIA BLVD
ASTORIA NY
11102-4751
US

IV. Provider business mailing address

9477 WHITE HORSE WAY
ELK GROVE CA
95624-6057
US

V. Phone/Fax

Practice location:
  • Phone: 917-419-6905
  • Fax:
Mailing address:
  • Phone: 916-724-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: