MEDICARE: MS. LINESHA SHAMARA DAVIS PA-C

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	363AM0700X	Medical Physician Assistant	MA056390	PA
2	363A00000X	Physician Assistant	PA9108584	FL

General Provider Information

NPI Number	:	1861828998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINESHA SHAMARA DAVIS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 25487
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-2487
Country	:	US
Telephone Number	:	941-259-0926
Fax Number	:	855-253-4836

Provider Business Practice Location Address
First Line	:	2209 NORTH BLVD W
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8903
Country	:	US
Telephone Number	:	863-679-8000
Fax Number	:	863-679-2694

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	10/24/2023

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