Provider Demographics
NPI:1104581404
Name:DAVIS, ELISABETH SARA (DACM)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:SARA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1211 VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-4858
Mailing Address - Country:US
Mailing Address - Phone:917-952-7151
Mailing Address - Fax:
Practice Address - Street 1:1211 VINEYARD ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-4858
Practice Address - Country:US
Practice Address - Phone:917-952-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006796-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist