Provider Demographics
NPI:1750838918
Name:DAVIS, FOLASHADE
Entity Type:Individual
Prefix:
First Name:FOLASHADE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FOLASHADE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 DEER PARK ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1322
Mailing Address - Country:US
Mailing Address - Phone:631-398-9754
Mailing Address - Fax:
Practice Address - Street 1:124 DEER PARK ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1322
Practice Address - Country:US
Practice Address - Phone:631-398-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor