Healthcare Provider Details

I. General information

NPI: 1508387572
Provider Name (Legal Business Name): JANELLE A DAVIS PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANELLE ALYIAH PRINCE

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ STE 300
CHESAPEAKE VA
23320-5055
US

IV. Provider business mailing address

1900 MERANO LN
CHESAPEAKE VA
23322-4446
US

V. Phone/Fax

Practice location:
  • Phone: 757-609-3380
  • Fax:
Mailing address:
  • Phone: 860-987-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012137
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126002804
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: