Provider Demographics
NPI:1568546182
Name:DAVYDOV, VALENTINA (DO)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:DAVYDOV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TITUS PL
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1455
Mailing Address - Country:US
Mailing Address - Phone:607-865-2400
Mailing Address - Fax:607-865-7305
Practice Address - Street 1:2 TITUS PL
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1455
Practice Address - Country:US
Practice Address - Phone:607-865-2400
Practice Address - Fax:607-865-7305
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02216842Medicaid
H59670Medicare UPIN
NY43V771Medicare ID - Type Unspecified