Healthcare Provider Details

I. General information

NPI: 1871900639
Provider Name (Legal Business Name): KATIE SHAYNA DAVIS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 73RD ST STE 5B1
NEW YORK NY
10021-3567
US

IV. Provider business mailing address

51 E 73RD ST STE 5B1
NEW YORK NY
10021-3567
US

V. Phone/Fax

Practice location:
  • Phone: 917-300-9146
  • Fax:
Mailing address:
  • Phone: 917-300-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number021287
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: