Healthcare Provider Details

I. General information

NPI: 1780277004
Provider Name (Legal Business Name): DARIJA DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH CAYUGA RD
WILLIAMSVILLE NY
14221
US

IV. Provider business mailing address

55 HANOVER ST
LANCASTER NY
14086-4445
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone: 724-989-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number762778-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number762778-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN635492
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: