Provider Demographics
NPI:1215376322
Name:DAVI, JOANN (BAED, MSED)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:DAVI
Suffix:
Gender:F
Credentials:BAED, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 ALCOLADE DR E
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3837
Mailing Address - Country:US
Mailing Address - Phone:631-399-0943
Mailing Address - Fax:631-399-0943
Practice Address - Street 1:142 ALCOLADE DR E
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3837
Practice Address - Country:US
Practice Address - Phone:631-399-0943
Practice Address - Fax:631-399-0943
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherNEW YORK STATE EDUCATION DEPARTMENT