Provider Demographics
NPI:1508628918
Name:DAVIS, MALAYSIA SIERRA
Entity Type:Individual
Prefix:
First Name:MALAYSIA
Middle Name:SIERRA
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 1:4139 QUENTIN BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8531
Mailing Address - Country:US
Mailing Address - Phone:614-779-2054
Mailing Address - Fax:
Practice Address - Street 1:4139 QUENTIN BLVD APT 208
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-8531
Practice Address - Country:US
Practice Address - Phone:614-779-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health