Provider Demographics
NPI:1043368640
Name:DAVIDSON, JACQUELINE Y
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:Y
Last Name:DAVIDSON
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 1:2841 CAMELOT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-3557
Mailing Address - Country:US
Mailing Address - Phone:757-953-3521
Mailing Address - Fax:757-953-7774
Practice Address - Street 1:2841 CAMELOT BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-3557
Practice Address - Country:US
Practice Address - Phone:757-953-3521
Practice Address - Fax:757-953-7774
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other