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General NPI Number Information
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NPI Number | 1154731149
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Entity Type | Individual
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Provider Name | SHAWNETTER DAVIS
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Gender | Female
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 5988 NW 27TH WAY
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City | JENNINGS
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State | FL
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Zip | 32053-2512
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Country | US
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Telephone | 386-855-2257
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Fax |
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Provider Business Mailing Address
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Address Line | 5988 NW 27TH WAY
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City | JENNINGS
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State | FL
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Zip | 32053-2512
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Country | US
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Telephone | 386-855-2257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 82992
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License Number State | FL
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