Healthcare Provider Details

I. General information

NPI: 1215481015
Provider Name (Legal Business Name): DANIA DAVIDSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-992-7669
  • Fax:
Mailing address:
  • Phone: 718-992-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: