Provider Demographics
NPI:1376357848
Name:DAVIS, TIMOTHY SHAWN (NBC-HWC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:SHAWN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 BARNSWALLOW PL APT D
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4832
Mailing Address - Country:US
Mailing Address - Phone:301-938-5273
Mailing Address - Fax:
Practice Address - Street 1:50 IRVING ST NW # 1E390
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A3403014171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach