Provider Demographics
NPI:1851663546
Name:DAVIS, CATHLEEN C (CDN)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 DEER PARK AVE.
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1314
Mailing Address - Country:US
Mailing Address - Phone:631-321-2100
Mailing Address - Fax:631-321-2246
Practice Address - Street 1:655 DEER PARK AVE.
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1314
Practice Address - Country:US
Practice Address - Phone:631-321-2100
Practice Address - Fax:631-321-2246
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004735133N00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist