MEDICARE: MRS. LA SHAWN ROSAMOND DAVIS LMSW

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	0577760	NY

General Provider Information

NPI Number	:	1689366551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LA SHAWN ROSAMOND DAVIS LMSW

Provider Business Mailing Address
First Line	:	229 W GENESEE ST # 1116
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-2604
Country	:	US
Telephone Number	:	716-308-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 GENESEE ST. N/A
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14211-1013
Country	:	US
Telephone Number	:	716-710-5151
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/23/2024

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