Provider Demographics
NPI:1043858681
Name:DAVIDSON- VOEGBORLO, ROSHELL DIONE
Entity Type:Individual
Prefix:
First Name:ROSHELL
Middle Name:DIONE
Last Name:DAVIDSON- VOEGBORLO
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 1:806 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-2808
Mailing Address - Country:US
Mailing Address - Phone:502-819-5456
Mailing Address - Fax:
Practice Address - Street 1:460 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3452
Practice Address - Country:US
Practice Address - Phone:812-280-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator