Provider Demographics
NPI:1073374518
Name:DAVIS, TAI'ASIA ASHLEY
Entity Type:Individual
Prefix:MS
First Name:TAI'ASIA
Middle Name:ASHLEY
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 1:659 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1119
Mailing Address - Country:US
Mailing Address - Phone:973-623-0600
Mailing Address - Fax:
Practice Address - Street 1:659 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1119
Practice Address - Country:US
Practice Address - Phone:973-623-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator