Provider Demographics
NPI:1013384577
Name:DAVIS, SHEILA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 720448
Mailing Address - Street 2:6644 GARY ROAD SUITE D,
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9600
Mailing Address - Country:US
Mailing Address - Phone:769-572-5158
Mailing Address - Fax:769-572-5158
Practice Address - Street 1:6644 GARY ROAD
Practice Address - Street 2:SUITE D BOX 720448
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9600
Practice Address - Country:US
Practice Address - Phone:769-572-5158
Practice Address - Fax:769-572-5158
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR859652363LF0000X
GARN24693363LF0000X
TN199994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily