Healthcare Provider Details

I. General information

NPI: 1831670728
Provider Name (Legal Business Name): SHANILLE CLARKE DAVIS COTA, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20018 SILVER MESIA CIR
CYPRESS TX
77433-6805
US

IV. Provider business mailing address

20018 SILVER MESIA CIR
CYPRESS TX
77433-6805
US

V. Phone/Fax

Practice location:
  • Phone: 954-608-5636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1116933
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN62319
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1116933
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1116933
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214385
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1116933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: