MEDICARE: DR. CECELIA DAVIDSON PH.D.

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	235Z00000X	Speech-Language Pathologist	005806-1	NY

General Provider Information

NPI Number	:	1174823744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECELIA DAVIDSON PH.D.

Provider Business Mailing Address
First Line	:	380 MALCOLM X BLVD
Second Line	:	APT. 3C
City	:	NEW YORK
State	:	NY
Zip	:	10027-2381
Country	:	US
Telephone Number	:	914-912-2329
Fax Number	:

Provider Business Practice Location Address
First Line	:	3942 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2902
Country	:	US
Telephone Number	:	347-398-8358
Fax Number	:	347-398-8359

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

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	08/18/2011

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