Provider Demographics
NPI:1457346447
Name:DAVIDOFF, SHIRLEY (FNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DAVIDOFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 WALNUT HILL LN STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3879
Mailing Address - Country:US
Mailing Address - Phone:214-369-3613
Mailing Address - Fax:
Practice Address - Street 1:8440 WALNUT HILL LN STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3879
Practice Address - Country:US
Practice Address - Phone:214-369-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107407363LF0000X
TX517271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148843901Medicaid
TX148843901Medicaid
S62742Medicare UPIN