Provider Demographics
NPI:1275145641
Name:DAVIS, SHAUNDY CAROLE (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNDY
Middle Name:CAROLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MULDOON RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1516
Mailing Address - Country:US
Mailing Address - Phone:907-717-8435
Mailing Address - Fax:
Practice Address - Street 1:207 MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1516
Practice Address - Country:US
Practice Address - Phone:907-717-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator