Provider Demographics
NPI:1366643371
Name:DAVAMONY, DAVID I (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:DAVAMONY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MDG, BUILDING 5522
Mailing Address - Street 2:30 NIGHTINGALE ROAD
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93524-1730
Mailing Address - Country:US
Mailing Address - Phone:661-277-5291
Mailing Address - Fax:
Practice Address - Street 1:95 MDG, BUILDING 5522
Practice Address - Street 2:30 NIGHTINGALE ROAD
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-1730
Practice Address - Country:US
Practice Address - Phone:661-277-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist