Provider Demographics
NPI:1083589618
Name:DAVIS, TATIANA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
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 1:24455 LAKE SHORE BLVD APT 1607
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1265
Mailing Address - Country:US
Mailing Address - Phone:440-954-2135
Mailing Address - Fax:
Practice Address - Street 1:3966 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6770
Practice Address - Country:US
Practice Address - Phone:440-340-5086
Practice Address - Fax:440-340-5035
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator