Provider Demographics
NPI:1780047282
Name:CARTER, DAVINA CHANTA
Entity type:Individual
Prefix:
First Name:DAVINA
Middle Name:CHANTA
Last Name:CARTER
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 1:37 WILDWOOD RD
Mailing Address - Street 2:#1
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1708
Mailing Address - Country:US
Mailing Address - Phone:410-340-6815
Mailing Address - Fax:
Practice Address - Street 1:37 WILDWOOD RD
Practice Address - Street 2:#1
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1708
Practice Address - Country:US
Practice Address - Phone:410-340-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor