Provider Demographics
NPI:1487398194
Name:DAVIS, SHELLEY ANN (NC LMBT)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NC LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PORTHOLE CT
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9370
Mailing Address - Country:US
Mailing Address - Phone:919-454-8402
Mailing Address - Fax:
Practice Address - Street 1:2603 N CROATAN HWY STE B
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9588
Practice Address - Country:US
Practice Address - Phone:919-454-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist