Provider Demographics
NPI:1710572029
Name:DAVIS, SHONDA LATOYA
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:LATOYA
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 1:2432 ATLAS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3704
Mailing Address - Country:US
Mailing Address - Phone:850-694-8152
Mailing Address - Fax:
Practice Address - Street 1:2432 ATLAS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3704
Practice Address - Country:US
Practice Address - Phone:850-694-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home