Provider Demographics
NPI:1740561422
Name:DAVIDSON, SHYLA
Entity Type:Individual
Prefix:
First Name:SHYLA
Middle Name:
Last Name:DAVIDSON
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 1:6750 HAMILTON CLEVES PIKE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMITOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45041
Mailing Address - Country:US
Mailing Address - Phone:513-203-8421
Mailing Address - Fax:513-353-2500
Practice Address - Street 1:6750 HAMILTON CLEVES PIKE RD
Practice Address - Street 2:
Practice Address - City:MIAMITOWN
Practice Address - State:OH
Practice Address - Zip Code:45041
Practice Address - Country:US
Practice Address - Phone:513-203-8421
Practice Address - Fax:513-353-2500
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.01766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist