Provider Demographics
NPI:1588931661
Name:DAVIS-PHINN, MICAELLA (MD)
Entity type:Individual
Prefix:DR
First Name:MICAELLA
Middle Name:
Last Name:DAVIS-PHINN
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 1:36 WASHINGTON PL E
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1715
Mailing Address - Country:US
Mailing Address - Phone:718-249-3437
Mailing Address - Fax:
Practice Address - Street 1:253 MUNGER PAVILION
Practice Address - Street 2:NEW YORK MEDICAL COLLEGE
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09647600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology