Healthcare Provider Details

I. General information

NPI: 1356216253
Provider Name (Legal Business Name): OHR HEALTH, DAVIA MOSS NURSE PRACTITIONER IN FAMILY HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SENECA ST FL 3
MANLIUS NY
13104-1872
US

IV. Provider business mailing address

100 E SENECA ST FL 3
MANLIUS NY
13104-1872
US

V. Phone/Fax

Practice location:
  • Phone: 315-380-1943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVIA MOSS
Title or Position: OWNER
Credential: NP
Phone: 315-380-1943