Provider Demographics
NPI:1013353788
Name:DAVEY, ELLEN C
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:C
Last Name:DAVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:D
Other - Last Name:SOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPD
Mailing Address - Street 1:25 BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8048
Mailing Address - Country:US
Mailing Address - Phone:516-795-2288
Mailing Address - Fax:516-795-3666
Practice Address - Street 1:25 BEVERLY PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8048
Practice Address - Country:US
Practice Address - Phone:516-795-2288
Practice Address - Fax:516-795-3666
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator