MEDICARE: MS. MICHELLE ANGELIQUE DAVIDSON MSED

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	252Y00000X	Early Intervention Provider Agency	1144774	NY

General Provider Information

NPI Number	:	1023497096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ANGELIQUE DAVIDSON MSED

Provider Business Mailing Address
First Line	:	2134 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3640
Country	:	US
Telephone Number	:	646-275-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2134 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3640
Country	:	US
Telephone Number	:	646-275-4500
Fax Number	:

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

Provider Enumeration Date	:	05/24/2015
Last Update Date	:	05/24/2015

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