Healthcare Provider Details

I. General information

NPI: 1922016138
Provider Name (Legal Business Name): CHERYL A WHITE-DAVIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ESSJAY RD
WILLIAMSVILLE NY
14221-8243
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-5782
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1102
  • Fax: 716-633-6507
Mailing address:
  • Phone: 716-630-1219
  • Fax: 716-817-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008767-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: