Provider Demographics
NPI:1588058846
Name:DAVIS, AISHA ANGELA (MD)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:ANGELA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1411
Mailing Address - Country:US
Mailing Address - Phone:475-323-6601
Mailing Address - Fax:203-755-3109
Practice Address - Street 1:179 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1411
Practice Address - Country:US
Practice Address - Phone:475-323-6601
Practice Address - Fax:203-755-3109
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292654208000000X
CT73804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY292654OtherSTATE LICENSE
CT73804OtherSTATE LICENSE