Provider Demographics
NPI:1215215637
Name:DAVIDS, MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:DAVIDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3104
Mailing Address - Country:US
Mailing Address - Phone:617-855-2032
Mailing Address - Fax:
Practice Address - Street 1:16 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3104
Practice Address - Country:US
Practice Address - Phone:617-855-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDR.00007672084P0800X
GA861732084P0800X
IDOC-00772084P0800X
ALDO.23002084P0800X
ND167032084P0800X
NE22232084P0800X
NVCL00932084P0800X
IL0361535052084P0800X
WAOP610855902084P0800X
WI127-3212084P0800X
TN41232084P0800X
AZ0087112084P0800X
MN678952084P0800X
MS278972084P0800X
MA2624542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry