Provider Demographics
NPI:1043061278
Name:DAVIS, SHUANA J
Entity Type:Individual
Prefix:
First Name:SHUANA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 HIDDEN RIVER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1114
Mailing Address - Country:US
Mailing Address - Phone:813-481-9662
Mailing Address - Fax:813-704-2600
Practice Address - Street 1:8610 HIDDEN RIVER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1114
Practice Address - Country:US
Practice Address - Phone:813-481-9662
Practice Address - Fax:813-704-2600
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician