Healthcare Provider Details

I. General information

NPI: 1205752664
Provider Name (Legal Business Name): DARRELL DAVIS JR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENECA ST
BUFFALO NY
14204-1963
US

IV. Provider business mailing address

1695 ELMWOOD AVE APT 23
BUFFALO NY
14207-2474
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-2800
  • Fax:
Mailing address:
  • Phone: 716-861-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number337662-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: