MEDICARE: KELLEY DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	125318-01	NY

General Provider Information

NPI Number	:	1003759374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY DAVIS

Provider Business Mailing Address
First Line	:	55 SUNKEN ORCHARD LN
Second Line	:
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-4006
Country	:	US
Telephone Number	:	516-606-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 SUNKEN ORCHARD LN
Second Line	:
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-4006
Country	:	US
Telephone Number	:	516-606-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ KELLEY DAVIS ” Practice Location

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