Provider Demographics
NPI:1609319417
Name:DAVIS, SABRINA
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
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 1:11220 KNOWLTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1357
Mailing Address - Country:US
Mailing Address - Phone:216-308-7078
Mailing Address - Fax:
Practice Address - Street 1:11220 KNOWLTON AVE.
Practice Address - Street 2:
Practice Address - City:CLEVLAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1357
Practice Address - Country:US
Practice Address - Phone:216-308-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324322860804376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide