Provider Demographics
NPI:1316608318
Name:DAVIS, SHERITA RENEA
Entity type:Individual
Prefix:
First Name:SHERITA
Middle Name:RENEA
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 1:2601 CARTWRIGHT RD # 122
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2613
Mailing Address - Country:US
Mailing Address - Phone:832-983-0195
Mailing Address - Fax:
Practice Address - Street 1:2601 CARTWRIGHT RD # 122
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2613
Practice Address - Country:US
Practice Address - Phone:832-983-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18060070172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver