MEDICARE: TIFFANY DAVILA

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	030690	NY

General Provider Information

NPI Number	:	1861075947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DAVILA

Provider Business Mailing Address
First Line	:	86 WEDGEWOOD DR
Second Line	:
City	:	HAUPPAUGE
State	:	NY
Zip	:	11788-3419
Country	:	US
Telephone Number	:	631-662-6462
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 STARR ST FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2705
Country	:	US
Telephone Number	:	718-418-6389
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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Directions to “ TIFFANY DAVILA ” Practice Location

Language	Start Address	Practice Location

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