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General NPI Number Information
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NPI Number | 1073654547
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Entity Type | Organization
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Legal Business Name | DIANE DAVIS PA
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 8050 OLD CR 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6457
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Country | US
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Telephone | 727-375-0600
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Fax | 727-375-1117
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Provider Business Mailing Address
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Address Line | 8050 OLD CR 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6457
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Country | US
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Telephone | 727-375-0600
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Fax | 727-375-1117
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Authorized Official
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Title or Position | OWNER
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Name | DIANE DAVIS
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Credential | MS CCC SLP
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Telephone | 727-375-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA5926
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License Number State | FL
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