Healthcare Provider Details

I. General information

NPI: 1689366551
Provider Name (Legal Business Name): LA SHAWN ROSAMOND DAVIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/23/2024
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 GENESEE ST. N/A
BUFFALO NY
14211-1013
US

IV. Provider business mailing address

229 W GENESEE ST # 1116
BUFFALO NY
14202-2604
US

V. Phone/Fax

Practice location:
  • Phone: 716-710-5151
  • Fax:
Mailing address:
  • Phone: 716-308-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0577760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: