Provider Demographics
NPI:1609298975
Name:DAVIS, SARANANDA (LMT)
Entity Type:Individual
Prefix:
First Name:SARANANDA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3511
Mailing Address - Country:US
Mailing Address - Phone:541-224-8133
Mailing Address - Fax:541-343-1455
Practice Address - Street 1:131 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3511
Practice Address - Country:US
Practice Address - Phone:541-224-8133
Practice Address - Fax:541-343-1455
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist