Healthcare Provider Details

I. General information

NPI: 1427962661
Provider Name (Legal Business Name): SHANIECE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 REILEY CT
RACINE WI
53403-1760
US

IV. Provider business mailing address

1114 REILEY CT
RACINE WI
53403-1760
US

V. Phone/Fax

Practice location:
  • Phone: 608-236-3135
  • Fax:
Mailing address:
  • Phone: 608-236-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: