Healthcare Provider Details

I. General information

NPI: 1184986903
Provider Name (Legal Business Name): SHAUNDELL MARCIA DAVIS-THOMAS MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 MAIN ST APT 414
NEW ROCHELLE NY
10801-7265
US

IV. Provider business mailing address

543 MAIN ST APT 414
NEW ROCHELLE NY
10801-7265
US

V. Phone/Fax

Practice location:
  • Phone: 914-632-1388
  • Fax:
Mailing address:
  • Phone: 914-632-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number475951309
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number475951309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: