Provider Demographics
NPI:1699726729
Name:DAVIS, WENDY SUE (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
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 1:108 CHERRY ST
Mailing Address - Street 2:P O BOX 70
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-0070
Mailing Address - Country:US
Mailing Address - Phone:802-863-7347
Mailing Address - Fax:802-863-7229
Practice Address - Street 1:108 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-863-7347
Practice Address - Fax:802-863-7229
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009079Medicaid
VTC65429Medicare UPIN
VTVT9079Medicare ID - Type Unspecified