Provider Demographics
NPI:1427389956
Name:DAVIS, JACQUELINE SHERRELL
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SHERRELL
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 1:1289 ROUTE 38 WEST
Mailing Address - Street 2:
Mailing Address - City:HAINSEPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2730
Mailing Address - Country:US
Mailing Address - Phone:609-267-5656
Mailing Address - Fax:609-276-8892
Practice Address - Street 1:218A SUNSET ROAD
Practice Address - Street 2:SRREENING, CRISI & INTERVENTINO PORGRAM (SCIP)
Practice Address - City:WILLIINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1110
Practice Address - Country:US
Practice Address - Phone:609-835-6180
Practice Address - Fax:609-835-7962
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker