Healthcare Provider Details

I. General information

NPI: 1801282090
Provider Name (Legal Business Name): LAUREN ASHLEY DAVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN ASHLEY MACEDONIA

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CENTRAL AVE # 344
FISHERS ISLAND NY
06390-7836
US

IV. Provider business mailing address

463 MADELINE AVE # 306
FISHERS ISLAND NY
06390-7881
US

V. Phone/Fax

Practice location:
  • Phone: 631-788-7244
  • Fax:
Mailing address:
  • Phone: 631-788-7244
  • Fax: 631-788-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number344851
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number344851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: