Provider Demographics
NPI:1427315415
Name:DAVIS, KENYANI SHAREEN (MD)
Entity type:Individual
Prefix:
First Name:KENYANI
Middle Name:SHAREEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENYANI
Other - Middle Name:SHAREEN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 YOUNGS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2698
Mailing Address - Country:US
Mailing Address - Phone:716-961-9900
Mailing Address - Fax:716-961-9911
Practice Address - Street 1:1020 YOUNGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2698
Practice Address - Country:US
Practice Address - Phone:716-961-9900
Practice Address - Fax:716-961-9911
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04500074Medicaid
NY04500074Medicaid