Provider Demographics
NPI:1356570584
Name:DAVEY, SHAUNETTE (DO)
Entity type:Individual
Prefix:
First Name:SHAUNETTE
Middle Name:
Last Name:DAVEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5445 MERIDIAN MARK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4767
Mailing Address - Country:US
Mailing Address - Phone:404-255-1933
Mailing Address - Fax:404-256-7924
Practice Address - Street 1:3023 HAMAKER CT STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2241
Practice Address - Country:US
Practice Address - Phone:571-776-3100
Practice Address - Fax:571-776-3091
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102204188207X00000X, 207X00000X
GA85488207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103504587Medicaid