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NPI Code Detail

MEDICARE: CRYSTAL DAVIS

MEDICARE: CRYSTAL 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1821929712
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL DAVIS
Provider Business Mailing Address
First Line : 324 COUNTY ROUTE 51 BLDG 1
Second Line :
City : MALONE
State : NY
Zip : 12953-4502
Country : US
Telephone Number : 518-483-1251
Fax Number : 518-483-2242
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 315-755-1251
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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Directions to “ CRYSTAL DAVIS ” Practice Location

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