Provider Demographics
NPI:1124790787
Name:DAVIS, SHATERIAL
Entity type:Individual
Prefix:
First Name:SHATERIAL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 GRAND CENTRAL PKWY APT 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-5042
Mailing Address - Country:US
Mailing Address - Phone:850-447-1220
Mailing Address - Fax:
Practice Address - Street 1:2370 GRAND CENTRAL PKWY APT 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-5042
Practice Address - Country:US
Practice Address - Phone:850-447-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health