Healthcare Provider Details

I. General information

NPI: 1457268112
Provider Name (Legal Business Name): GWENDOLYN N DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SHEPHERD AVE
BROOKLYN NY
11208-1233
US

IV. Provider business mailing address

201 SHEPHERD AVE
BROOKLYN NY
11208-1233
US

V. Phone/Fax

Practice location:
  • Phone: 954-263-3528
  • Fax: 646-417-6019
Mailing address:
  • Phone: 954-263-3528
  • Fax: 646-417-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: