Provider Demographics
NPI:1619181963
Name:DAVIS, SHERYL (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1414
Mailing Address - Country:US
Mailing Address - Phone:516-432-4567
Mailing Address - Fax:267-523-0005
Practice Address - Street 1:911 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1414
Practice Address - Country:US
Practice Address - Phone:516-432-4567
Practice Address - Fax:267-523-0005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003801-1111N00000X
CA15773111N00000X
CT453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX 21561Medicare UPIN