Provider Demographics
NPI:1972304160
Name:DAVIS, SHAVON A (RN MSN IBCLC)
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:
Credentials:RN MSN IBCLC
Other - Prefix:
Other - First Name:SHAVON
Other - Middle Name:A
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8015 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2327
Mailing Address - Country:US
Mailing Address - Phone:510-214-2330
Mailing Address - Fax:
Practice Address - Street 1:2450 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-214-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317422163WL0100X
CA95229454163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant