Provider Demographics
NPI:1720874050
Name:DAVISS, SHANTIA SHAQWANA
Entity type:Individual
Prefix:
First Name:SHANTIA
Middle Name:SHAQWANA
Last Name:DAVISS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 TRUITTVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5992
Mailing Address - Country:US
Mailing Address - Phone:919-698-2512
Mailing Address - Fax:
Practice Address - Street 1:310 BRATTON DR STE A
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7827
Practice Address - Country:US
Practice Address - Phone:919-307-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician