Provider Demographics
NPI:1194956797
Name:DAVIS, SHEILA ESTELLE (DO)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:ESTELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W CAMBRIA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-2632
Mailing Address - Country:US
Mailing Address - Phone:215-578-3300
Mailing Address - Fax:215-578-3335
Practice Address - Street 1:2100 W CAMBRIA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2632
Practice Address - Country:US
Practice Address - Phone:215-578-3300
Practice Address - Fax:215-578-3335
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006992-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA356596Medicare PIN