Provider Demographics
NPI:1558857524
Name:DAVIS, SHANNON DENISE
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DENISE
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 1:4818 BASS PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5147
Mailing Address - Country:US
Mailing Address - Phone:202-285-3258
Mailing Address - Fax:
Practice Address - Street 1:2902 ERIE ST SE # 65
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3143
Practice Address - Country:US
Practice Address - Phone:202-705-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant