Provider Demographics
NPI:1124873021
Name:DAVIS, SISSMOL (MBBS)
Entity type:Individual
Prefix:
First Name:SISSMOL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 MAINSTREET
Mailing Address - Street 2:SISTERS OF CHARITY HOSPITAL, 5TH FLOOR DEPARTMENT OF ME
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-862-1423
Mailing Address - Fax:716-862-1871
Practice Address - Street 1:2157 MAINSTREET
Practice Address - Street 2:SISTERS OF CHARITY HOSPITAL, 5TH FLOOR DEPARTMENT OF ME
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-862-1423
Practice Address - Fax:716-862-1871
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2025-02-04
Deactivation Date:2024-12-23
Deactivation Code:
Reactivation Date:2025-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program