Provider Demographics
NPI:1245446251
Name:DAVIS, NICHOLETE MICHELLE (AUD)
Entity type:Individual
Prefix:DR
First Name:NICHOLETE
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 SPRUCE ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6683
Mailing Address - Country:US
Mailing Address - Phone:580-678-3720
Mailing Address - Fax:
Practice Address - Street 1:1924 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2118
Practice Address - Country:US
Practice Address - Phone:856-424-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00080600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist